sports Essays (192 words) - Order Of Interbeing, Engaged Buddhism

is having an interesting life. He is known for many things. These include he talks during the Vietnam War for peace, organizing help for villages, instituting schools for youths, and has been nominated for the Nobel Peace Prize by Martin Luther King Jr. Thich Naht Hahn has one of the most amazing backgrounds that lead up to the legacy of this Nobel Peace Prize Nominee. Thich Naht Hahn has been living in exile from his native land of Vietnam since he was forty years old. In 1966, he was banned by both the non-Communist and Communist governments for his role in undermining the violence he saw affecting his people. He has been a Buddhist monk since he was 16 years old, he earned a reputation as a respected writer, scholar, and leader. He is known as Thay (Teacher) to his followers. He has headed a movement known as Engaged Buddhism, which involved traditional meditative practices with active nonviolent civil disobedience. This movement lays behind the establishment of the most influential center of Buddhist studies in Saigon, the An Quang Pagoda. He has also set up relief organizations to rebuild destroyed vil

Rude Literary Agents

Rude Literary Agents A long-time follower and fellow mystery author wrote me recently after the smack-down from a rude literary agent. I recently got a nasty rejection letter from an agent that said, When we said we were looking for new Southern writers, we were looking for the next Pat Conroynot the next Dukes of Hazzard. I should have been insulted, but it kind of rings true, and I reminded her the show was on the air for seven years! A back-wood badge of honor! I understood. An agent once asked me in a rejection letter, Why would we want a book about an insurance agent? She was talking about Carolina Slade, the protagonist in my original mystery series who was an investigator for agriculture. My first instinct at reading that ignorance was that I didnt need an agent with that attitude or lack of sense, and I considered that rejection as me dodging a bullet. Ive been to enough writers conferences to see agents act foolishly, behaving as if they were royalty walking amongst the commoners. Theyve laughed on panels at the naivete of certain writers, chuckled behind their hands during blind critiquing panels, and sat at tables at banquets, only with other agents, mind you, while sniggering at the speakers. Regardless of how lofty these souls think they are, you do not want that personality representing you. They will not be loyal. If they sign you, youll be the current favorite toy until a brighter, shinier thing comes along. Last week, I spoke of self-respect. The more self-assured you are, the better your chances are of landing an agent. . . the right agent. Of course, your writing has to be good, but if you are confident in yourself, a good agent will recognize that strength. Theyll see you wont be deterred Most of all, theyll see that youre interested in creating your stories and spreading them to the world, and thats what any reputable agent wants, too.

Applying Arguments about Economics and Place Essay

Applying Arguments about Economics and Place - Essay Example It gives a detailed explanation of why the poorer people in the United States of America seem to acquire and store more invaluable stuff as compared to the fairly financially stable people. According to Paul Graham’s article, one of the articles in unit two, the contemporary American market is full of cheap stuff as compared to the traditional America (Paul 1). People used to undervalue stuff and only accumulated only a portion of what they bought and considered absolutely valuable to them. In the contemporary America, however, people seem to overvalue stuff despite the fact that they are cheaper as compared to the traditional stuff. Paul tries to give an explanation to why poorer people are more likely to value stuff with lesser value as compared to the fairly rich people. He explains that he would pick things left by friends when they moved to new homes because he was poor, and useless stuff seemed useful to him. This is an implication that poor feel that they will perhaps make use of stuff in the future despite the fact that the same stuff might be useless to them at that particular moment (Paul 1). That is a confirmation of the uncertain future that the poor face. Paul further explains that stuff in an illiquid asset and this might only change when one finds immediate use for it. In addition to that, stuff becomes a liquid asset only when one sells the stuff immediately he or she acquires it at a higher price compared to the buying prices. Therefore, stuff that is accumulated over a period of time becomes uneconomical. As a matter of fact, the stuff becomes expensive to keep because it occupies space thereby demanding for storage space. For this reason, Paul explains that it is worth noting that once one does not have immediate use for whatever he or she is trying to acquire, he or she probably never will have use for that object (Paul 1). The increase of stuff in the markets, both used and new, is attributed to the increased

Parker vs. Twentieth-Century Fox Corp Essay Example | Topics and Well Written Essays - 1500 words

Parker vs. Twentieth-Century Fox Corp - Essay Example Facts The plaintiff is well known as an actress and in the contract signed by the defendant and the plaintiff; at times she is referred to as the artist. According to the contract as of the 6th of August 1965, she was meant to play female lead role in the contemplated production of Bloomer Girl, a movie by the defendant. The contract provided that the plaintiff would be paid a guaranteed minimum compensation of $53,571.42 every week for the fourteen weeks commencing the 23rd of May 1965. The total pay amounted to seventy five thousand dollars. Before May of 1966, the defendant decided against the picture’s production and in a letter dated 4th April 1966 notified the plaintiff of the very same decision telling her that it would not be in compliance with their earlier obligations under the written contract (Blond 25). In the same letter, the defendant, with a professed purpose meant to â€Å"avoid any damage† to the plaintiff, instead gave the plaintiff the leading actres s role in yet another film. This film was tentatively titled â€Å"Big Country, Big Man†, referred to hereafter as â€Å"Big Country†. The defendant offered an identical compensation, as they did with thirty-one of the other thirty-four articles or provisions of the original contract. However, Bloomer Girl, as compared to Big Country, was a Western type, dramatic movie, not a musical like the earlier Bloomer Girl. Bloomer Girl was to have been shot in California while Big Country’s location was in Australia. In addition, other certain terms in the contract proffered varied from the contract drawn up initially. The plaintiff was given 1 week to accept the offer, which she failed to do until the offer elapsed. The plaintiff hereby commenced the court case seeking the agreed guaranteed compensation’s recovery (Mann and Barry 45). The complaint set two causes of action forth. Firstly, she wanted monetary compensation due under the previous contract. Secondly, she wanted to sue for damages that resulted from a breach of contract by the defendant. In its answer, the defendant admitted the existence, as well as the validity of the contract, and that the plaintiff complied with all the promises, covenants, and conditions of the contract. She was also ready to comply with the completion of the performance and that she had anticipatorily repudiated and breached the signed contract. However, the defendant denied owing any money to the plaintiff, either under the terms of the contract or resulting from its breach and pleaded an affirmative defense to both causes of the plaintiff’s action. They assert that she willfully failed to mitigate damages, asserting that she turned down, unreasonably, and its offer of a leading role in the film Big Country. The plaintiff moved for summary judgment under the code of civil procedure section 437c. She was granted the motion and summary judgment for seven hundred and fifty thousand dollars with additi onal interest (Mann et al. 72). Issue Whether a secondary offer, of employment was enough to mitigate the damages from the contract’s breach and whether summary judgment should stand. Decision Summary was granted where facts are presented that give rise to an issue that is factually triable and not in dispute. The salary amount agreed upon acts as the measure of recovery minus the amount earned by

World War One To An Armistice In 1918 History Essay

World War One To An Armistice In 1918 History Essay The failure of the spring offensive in 1918 indicated that Germanys military defeat was imminent. The collapse of Bulgaria and the desperate situation on the Western Front, which was only made worse by the intervention of the American troops, made the Germans take further steps. The German military leaders feared an absolute collapse of the front and that the enemies could make their way farther and could thus claim and take over German territory. In August 1918 the Allies fought the Germans back from their fronts and Ludendorff, a German general, had to inform the Kaiser: We have nearly reached the limit of our powers of resistance. The war must be ended. In September 1918 the German government began negotiations on an armistice with the American President Woodrow Wilson whose 14-points they expected to bring about a peace treaty without too much loss. At the end of September 1918 Bulgaria made peace and one month later Turkey was defeated. Austria was defeated by the Italians at Vittorio Veneto and signed an armistice with the Allies. Germany was now fighting the Allies alone. They had no other choice than to sign an armistice with the Entente in Compià ©gne, France on November 11. This treaty marked the end of World War One. Exhaustion at the front But where did the exhaustion at the front and the necessity of an armistice come from? The first and major reason is that the conditions the soldiers at the fronts had to live with were disastrous. They led to exhaustion and war weariness. When the war began many young men rushed to join the armies to proudly fight for their fatherlands. The British government asked for 100,000 volunteers but after just one month they already had 750,000. However, the peoples enthusiasm did not last. Everyone had believed the war would be over by Christmas 1914; nobody had expected they would continue fighting for four more years.  War-weariness set in. People, both at the so called home front and soldiers fighting at the actual front, were tired of war and disappointed that in spite of the large loss all the armies had suffered, and the fact that not any progress had been made, there was still no end in sight. Soldiers young men of 20 years only had seen their comrades wounded and die one after the other. Either killed by the enemies bullets or bombs or slowly dying of influenza or other disease, caused by the miserable conditions in the trenches. These brave men were fighting in a futile battle, between the dead bodies of their friends, suffering from extreme temperatures and hunger. As a result of the Allied blockade beginning in 1914 German soldiers were exceedingly poorly fed. The allied navies prevented ships sailing directly to Germany providing it with anything that could be used for making war (including food) in order to starve the Germans until they give up and surrender. The Allies also had an overwhelming superiority in artillery, tanks and mechanised transport and their equipment was greatly superior. The Germans had to rely on their superior skill, but they didnt have a top-down command structure like the British or the French. It is said that the Germans were tactically unsurpassed, but operationally deficient and strategically inept. So it was not military prowess that led to the Armistice. A part of the German military leaders didnt want to admit their failure in the battlefield. They claimed that the German army had actually been undefeated and their failure was only due to unpatriotic civilians and treacherous politicians at the home front stabbing their own forces in the back. This untrue theory was called stab-in-the-back-theory (German: Dolchstoßlegende). Exhaustion at the home front But it was not that people at the home front were being unpatriotic that led to the German defeat. Of course many people had lost their belief in their fatherland, but in fact it was the same exhaustion and war weariness as in the battlefield that forced the German leaders to start negotiating about an armistice. Generally the word home front indicates the inclusion of the civil population into warfare, even if the actual front is outside of the populations lebensraum. And indeed, they were involved and suffering from the effects of the war. The biggest problem at the home front was the acute food shortage bare hunger. The civilian population of Germany was suffering. Although the German U-Boat campaign had led to food shortages in Britain the Allied naval blockade that prevented supplies from getting into German ports hit Germany harder. Even worse was that the shortage of food during the war had led to an inflation, a rise in the general level of prices of goods. So those little supplies of food that were available was often not affordable for the common family. Even fuel was short supply and limited. Furthermore the influenza epidemic of 1918 and 1919 killed between 20 and 40 million people in Europe. The so called Spanish Flu also hit German cities and claimed many lives amongst the people, who already suffered from and were weakened by the lack of food. In November 1918 the population was not willing to accept this situation anymore. Strikes and demonstrations paralysed Berlin. Workers went on strike, soldiers refused orders, and the German navy mutinied. The strike and protest spread all over the country. Within a week, there was no more German city that was not involved into the demonstrations, protests and strike developed into a revolution. On 9 November 1918 Germany was declared a democratic republic, which was followed by the formal abdication of Kaiser Wilhelm II. On 11 November the Armistice of Compià ¨gne was signed by Center Party deputy Matthias Erzberger. World War I was officially over. Conclusion Exhaustion on the front and on the home front, not military prowess, brought World War I to an Armistice in 1918. The major reasons for the exhaustion were the large losses that the countries had suffered without making any progress. Bad conditions in the battlefield such as hunger and disease caused war weariness. Hunger and very bad living conditions caused exhaustion and war weariness on the home front. The German people was not willing to take this anymore and started a revolution in November. Germany became a republic and finally signed the Armistice of Compià ¨gne on November 11. The Great War was over! An essay by Katharina Voß The information was found at the following pages: http://www.bbc.co.uk/scotland/learning/bitesize/standard/history/1890_1920/end_of_great_war_rev1.shtml http://www.bbc.co.uk/history/worldwars/wwone/german_experience_01.shtml#three http://www.firstworldwar.com/diaries/braveryinthefield.htm http://www.historylearningsite.co.uk/home_front_1914_to_1918.htm http://de.internationalism.org/Welt150_nov1918

Software Piracy :: essays research papers

Software Piracy What is Software Piracy The PC industry is just over 20 years old. In those 20 years, both the quality and quantity of available software programs have increased dramatically. Although approximately 70% of the worldwide market is today supplied by developers in the United States, significant development work is occurring in scores of nations around the world. But in both the United States and abroad, unauthorized copying of personal computer software is a serious problem. On average, for every authorized copy of personal computer software in use, at least one unauthorized copy is made. Unauthorized copying is known as software piracy, and in 1994 it cost the software industry in excess of US$15 billion. Piracy is widely practiced and widely tolerated. In some countries, legal protection for software is nonexistent (i.e., Kuwait); in others, laws are unclear (i.e. Israel), or not enforced with sufficient commitment (i.e., the PRC). Significant piracy losses are suffered in virtually every region of the world. In some areas (i.e., Indonesia), the rate of unauthorized copies is believed to be in excess of 99%. Why do People Use Pirated Software? A major reason for the use of pirated software is the prices of the REAL thing. Just walk into a CompUSA, Electronics Boutique, Computer City, Egghead, etc and you will notice the expensive price tags on copies of the most commonly used programs and the hottest games. Take the recent Midwest Micro holiday catalogue for example and notice the prices. Microsoft Windows 95: $94, Microsoft Office 95: $224, Microsoft Visual C++: $250, Borland C++: $213, Corel Draw 7: $229, Corel Office Professional 7: $190, Lotus Smartsuite 96: $150, Microsoft Flight Simulator95: $50, Warcraft 2: $30. The list goes on and on and the prices for the programs listed above were only upgrade versions. Users of the software listed above include anywhere from large companies like AT&T to yourself, the average user at home. Although a $30 game like Warcraft 2 doesn't seem like much, by the time you finish reading this paper, it will seem like a fortune. Ease of Availability Since the law states clearly that making a copy of what you own and distributing it or installing more than one copy of one piece of software on two separate computers is illegal, then why do the average Joes like you and us still do it? There are many answers to that question and all of them seem legitimate except that no answers can be legally justified. A friend borrowing another friend's Corel draw or Windows 95 to install on their own PC is so common that the issue of piracy probably doesn't even come to mind right away or

Pathophysiology Paper

Running Head: Integrated Pathophysiology Integrated Pathophysiology Paper Confidential RNSG 2463 Instructor Date Integrated Pathophysiology 2 Patient Data Mr. F. is a seventy-three year old Caucasian male who is twice divorced and lives alone in Sweetwater, Texas. He has two children living, and two deceased children. Both of his parents are deceased; his father died at the age of sixty-nine of prostate cancer, his mother at the age of seventy-two of a stroke. He is self-employed, owning a local dirt contracting company for about thirty years now. Mr. F. tands five-foot and nine inches tall and weighs two hundred sixty pounds, exhibiting moderate obesity and has been for the past twenty-five years. He has a longstanding history of hypertension; approximately twenty years as well as a history of diabetes mellitus type two for twelve years, never having been insulin dependant. He has a smoking history of about fifty years smoking two packs per day and has been diagnosed a few years ago with chronic obstructive pulmonary disease, making him oxygen-dependant for two years. He claims to only drink alcohol on a social basis.Prior to his current admission, he stated that he has not been compliant with his diabetic diet, that he does not check his blood glucose regularly nor has he been following his medication regimen as he should. His last doctors appointment was two years ago. On July 6, 2008, Emergency Medical Services was called to Mr. F. ’s residence by a friend who found him in bed, conscious, but speaking incoherently. He had a nasal canula in place at three liters per minute. His glucometer done by emergency personnel showed a blood sugar of thirty-six.He was then given a bolus of dextrose fifty percent; he then returned to consciousness, but complained of some right arm and leg weakness. He had 3+ pitting edema bilaterally to lower extremities as well as 1+ presacral edema. He was then transported to Rolling Plains Memorial Hospital emergency room. Upo n arrival to the hospital, his vital signs were as follows; blood pressure- 200/103, heart rate- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per minute. His right sided weakness seemed to resolve per patient.He denied headache, vertigo and tinnitus. Diagnostics done at the emergency room showed a white blood cell count of 7. 8, hemoglobin of 12. 4, hematocrit of 37. 2, MCV of 95, and the platelet count along with coagulation studies showed to be normal. His renal function was abnormal at a BUN of 68 and a creatinine of 6. 1. His potassium level was 5. 4 and CO2 was 22. 3. His sodium level was 133, phosphorus levels were elevated at 6. 1, globulins were elevated at 4. 3, troponin level was slightly elevated at 0. 14 and CPK was normal. His BNP NT-Type was extremely elevated at 9674. along with his hemoglobin A1C was at 5. 8. Thyroid studies were Integrated Pathophysiology 3 found to be normal. The total cholesterol was 127, with HDL only at 24, LDL at 79 and triglycerides at 136. A further diagnostic study revealed by way of chest x-ray has shown cardiomegaly with mild venous congestion. The EKG shows poor R wave progression and nonspecific ST wave changes from previous. The echocardiogram showed 2+ mitral valve regurgitation with mild aortic stenosis and also an ejection fraction of over 50%. A renal sonogram shows diffuse cystic changes.A CT scan of his head revealed mild white matter changes but no other abnormalities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190. 3. The patient denied problems with urination such as frequency, urgency, dysuria, recurrent urinary tract infections or renal stones. Home medications included; Potassium chloride 10 mEq t. i. d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b. i. d. for a total of 20 mg daily, Albuterol inhaler, Furosemide 80 mg in the am and 40 mg in the pm. Mr. F. was admitted into the intensive care unit from the emergency room.Diseases/Pathophysiology Mr. F. ’s current disease processes are long-standing hypertension, obesity, COPD, Diabetes mellitus, chronic renal failure, and congestive heart failure. Hypertension is defined as a blood pressure greater than 140/90 mm Hg (Ignatavicius & Workman, 2006). It is caused by increases in cardiac output, total peripheral resistance, or both. The cardiac output is the volume of blood that is ejected by the heart each minute. Peripheral resistance is a resistance to the flow of blood out side of the heart. It can be considered either primary or secondary.Primary hypertension has no known causative factors other than relation to genetic predisposition, obesity, stress, increased alcohol intake, diabetes, and or sodium and water retention in which all increase the total workload of the heart and increase fluid volume with in the vascular space (Zerwekh, Claborn & Gaglione, 2006). Secondary hypertension is elevated blood pressure with a n identifiable cause that may include but not limited to; renal stenosis, congenital heart defects, Cushing’s syndrome, pheochromocytoma, untreated sleep apnea, MAOIs, chemical stimulants such as cocaine, methamphetamines etc. or pregnancy induced (Zerwekh, Claborn & Gaglione, 2006). Obesity is a disease within many diseases with many varying causes. According to Ignatavicius and Workman (2006), an obese person weighs at least 20% above the upper limit of the normal range for ideal body weight and refers to an excessive amount of body fat in which can be distributed differently and cause an array of problems according to the distribution, Integrated Pathophysiology 4 especially android obesity with excess fat at the waist and abdomen; this pattern carries the greatest health risk.Chronic Obstructive Pulmonary Disease is a progressive and irreversible condition characterized by diminished inspiratory and expiratory capacity of the lungs (Mosby’s, 2002). Emphysema along with chronic bronchitis is complications that lead to COPD. The etiology is more often than not, a long history of smoking cigarettes or other forms of smoking tobacco. The lungs lose elasticity and tend to cause hyperinflation due to the alveoli in the lung losing its elastin, in which then narrows and produces a surface area that decreases and is no longer functioning properly for adequate gas exchange.The accumulated air that is unable to be absorbed properly becomes trapped and causes the collapse of the smaller airways called bronchioles. With the lungs hyperinflated, this flattens the diaphragm, thus causing the individual to utilize accessory muscles to breath, increasing the respiratory rate to compensate. Patients with COPD have bouts with chronic bronchitis which is an inflammation of the bronchi and bronchioles triggered usually by tobacco smoke.The irritants from the smoke cause inflammation, with vasodilation, mucosal edema, and bronchospasms; the increased inflammation increases the size of the mucosal glands and produce large amounts of thick mucus, causing the bronchial walls to thicken and impair airflow (Ignatavicius & Workman, 2006). Diabetes Mellitus comes in many forms; the main characteristic is elevated blood glucose due to complications in the insulin secretion or action or both (Ignatavicius & Workman, 2006).When diagnosed with diabetes other than type one, the beta cells in the islets of Langerhans that produce insulin and the alpha cells that produce glucagon, which counteract one another, either decrease in production of these hormones or can possibly produce at a normal balance. If there is normal production of these hormones, mainly insulin (the hormone that transports glucose into the cells), it is usually cellular resistance to insulin that is causing the diabetes.When the cells are not receiving the necessary glucose needed for cellular function and metabolism, the body is unable to utilize the glucose, store carbohydrates, fat s and proteins; therefore the unused glucose remains in the blood causing hyperglycemia and regulatory mechanisms in the body tend to cause the release of more glucagon which cause the release of stored glucose in the liver into the bloodstream as well, therefore increasing the blood glucose level even more. Homeostasis is Integrated Pathophysiology 5 nterrupted, systemically causing damage. The etiology of type two diabetes can be a combination of many factors; however the well known contributor is obesity. Chronic renal failure is a progressive, irreversible kidney injury, and kidney function does not recover (Ignatavicius & Workman, 2006). The kidneys are in charge of filtering the metabolic wastes in the bloodstream that comes from cellular metabolism throughout the body as well as reabsorption of necessary electrolytes.When long-term damage is sustained in the cells of the kidneys (nephrons) by factors such as longstanding hypertension, function is progressively altered exhibit ed by the inability to excrete the nitrogenous wastes; therefore they accumulate in the kidneys and blood stream. Altered glomerular filtration rate, abnormal urine production, poor water excretion, electrolyte imbalances, and metabolic abnormalities occur as a result of renal failure. The body’s ability to dilute urine is decreased; therefore urine output decreases causing fluid overload.The failure occurs in stages with the last being end-stage renal disease in which all renal function eventually ceases. Congestive heart failure also known as left-sided heart failure may result from hypertensive coronary artery and valvular diseases arising particularly from the mitral and aortic valves. When CHF occurs from any etiology such as systemic hypertension and structural changes, the ventricles of the heart are unable to contract and or relax properly causing blood to congest around the heart.As a result of this congestion in and around the heart, tissue perfusion diminishes and blood accumulates in the pulmonary vessels. Cardiac output eventually decreases and compensatory mechanisms such as sympathetic nervous system stimulation, the renin-angiotensin system activation in the kidneys (RAS), other neurohumoral responses and myocardial hypertrophy will occur (Ignatavicius & Workman, 2006).The hypoxic state of the tissues stimulate the nervous system which increases the heart rate and blood pressure due to vasoconstriction and this stimulation increases venous blood return to the heart, which in turn stretches the myocardial fibers causing dilation and eventually thickening of the walls of the heart and chambers within it, consequently causing enlargement (cardiomegaly). The heart then tries to contract harder and eventually exhausts and reduces the force of the contractions; therefore decreasing cardiac output.The vasoconstriction of the arteries increases the afterload which is the resistance that the heart must pump. This low output causes a decrease in b lood flow to the kidney’s which results in the activation of the RAS in turn causes sodium and water retention. Cardiac preload and afterload increase causing contractile dysfunction. Integrated Pathophysiology 6 Integration Mr. F. reported that he has been obese for approximately twenty-five years. A few years after the significant weight gain, he was diagnosed with hypertension.At his own admission, his lifestyle of high fat, cholesterol, salt and sugar intake as well as a long history of smoking cigarettes left little to be desired and have contributed significantly to his current condition. Several years after having been diagnosed with hypertension, he was told he had diabetes and COPD. Upon his recent hypoglycemic episode, he was diagnosed then as having chronic renal failure with congestive heart failure. All of these diagnoses tie well in together, starting with obesity. When a person is obese, the excess weight, especially around the waist and abdomen as seen in Mr.F . causes the workload on the heart to increase due to the excess adipose tissue surrounding the visceral organs and weight in general. Being obese puts one at high risk factors for developing hypertension and heart disease as Mr. F. has. Obesity also places one at high risk for developing diabetes type two due to the fact that adipose tissue and cells that accumulate have a high tendency to become insulin resistant as well as the surrounding cells and tissue; therefore the body can not utilize the glucose and hyperglycemia occurs.A prolonged period of insulin resistance eventually leads to the beta cell failure causing decreased insulin production. The same high fat, cholesterol, and sodium diet that contributed to the patient’s obesity in the first place, causing his heart to have to work harder, more than likely caused him to develop hypertension. The fact of his non-compliance with his medication regimen for hypertension and diabetes, 100 pack per year smoking habit as wel l as noncompliance with prescribed diabetic diet, lead to his further complications of renal failure and lastly CHF.With prolonged hypertension and particularly uncontrolled diabetes mellitus, diabetic nephropathy changes the kidneys in a way that reduces kidney function and eventually, renal failure. Chronic high blood glucose levels cause hypertension in kidney blood vessels and excess kidney perfusion (Ignavicius &Workman, 2006). This increase in pressure within the kidneys cause the blood vessels to leak out that allows large particles such as albumins and proteins to form deposits in the kidneys and their blood supply.This narrows the vessels and decreases oxygenation to surrounding kidney tissue; therefore causing hypoxia and eventually irreversible cell death. As this progresses, scarred tissue forms and the ability to filter urine from the blood ceases causing renal failure. Once in renal failure, the patient’s kidneys were not able to regulate the fluid volume by ade quate excretion, therefore the excess fluid was pooled back into the vascular Integrated Pathophysiology 7 space. This fluid volume overload caused an increased cardiac workload which eventually leads to congestive heart failure.Mr. F. ’s smoking history was the primary cause of his COPD; however it is exacerbated by the collection of fluid in his vascular space due to renal failure, the loss of elasticity of vascular system and congestive heart failure. The medication prescribed for Mr. F. ’s diabetes was Metformin 500 mg daily. This medication primary action was to decrease hepatic glucose production. The excess insulin in the blood triggers production of glucagon in which signals the liver to release stored glucose, in turn hyperglycemia results. This medication was changed due to Mr. F. s elevated BUN and creatinine which is where this medication is metabolized and excreted as well as his state of CHF. Continuing this medication could cause toxicity. The new medica tion he was placed on was a low dose of Actos which is metabolized in the liver and does not cause hypoglycemia as Metformin may. To treat his hypertension, Nifedipine was prescribed and it acts to lower blood pressure by inhibiting calcium transport into myocardial cells and smooth muscle cells within the vascular space resulting in vasodilation counteracting the vasoconstriction caused by hypertension.In addition to Nifedipine, the patient is prescribed an ACE inhibitor named Ramipril. This ACE inhibitor works on the renin-angiotensinogen system ultimately causing systemic vasodilation. This medication not only decreases the blood pressure, it decreases cardiac afterload in patients with CHF. Ramipril is metabolized in the liver, therefore indicated for patients at risk or in renal failure. Furosemide is a loop diuretic that is especially helpful in patients with edema due to hypertension, renal disease as well as CHF.Furosemide increases the renal excretion of water as well as so dium and other electrolytes, thus reduces the fluid volume in the vascular space. It also has a vasodilating effects that are beneficial in this patients regimen; however a potassium supplement must be given due to the potassium wasting caused by this loop diuretic. This patient’s dose of Furosemide was significantly increased due to the necessity of ridding his body of the accumulating fluid and stabilizing his blood pressure which in turn will prevent further damage to his kidney’s. Potassium is necessary for proper contractility of the heart.Mr. F. is on Potassium chloride 10 mEq t. i. d. to make up for the loss due to the loop diuretic effects. The Albuterol inhaler is used to dilate the bronchi thus increasing surface area of the air ways to enable oxygen and CO2 exchange. This inhaler can exacerbate hypertension, palpitations and have a negative cardiac effect as well as cause hyperglycemia; therefore must be used cautiously. Integrated Pathophysiology 8 Predicti on of Outcomes Although Mr. F. ’s acute condition was stabilized, his prognosis appears poor at this point due to his history of noncompliance.Even though he has decreased his cigarette habit to one pack per day, his condition will probably deteriorate unless he could totally abstain from smoking. While speaking with the patient, he assures that this has got his attention and he will remain compliant from here on out. The damage at this point is irreversible; therefore maintaining remaining function as it is now becomes a new priority, meaning that compliance is necessary at this point for this patient as continuing to be noncompliant will definitely lead to his demise.Aggressive diabetic counseling as well as reinforcement of adhering to his current medication regimen is crucial for this patient’s survival. Other disciplines that should be involved to ensure a better prognosis for Mr. F. are ones such as a dietician to help with meal and snack planning per diabetic pr otocol, continuing respiratory therapy to aid in oxygenation and supplies, physical therapy to build the patients strength and prevent venous stasis hence blood clots, and maybe even occupational therapy to assist him with maintaining independent activities of daily living.Routine follow up appointments with his physician as well as specialist for cardiac and pulmonary function are essential to his outcome. A diabetic support group would be ideal for this patient as he appears to be a person in need of a support team. Lifestyles are hard to modify, but when one gets backed into a corner, it can be done, even in the most noncompliant patients otherwise death is imminent. Integrated Pathophysiology 9References Deglin, J. H. & Vallerand, A. H. (2007). Davis’s Drug Guide, Tenth Edition. Philadelphia: F. A. Davis Company. Ignatavicius, D. D. & Workman, M. L. (2006). Medical Surgical Nursing, Critical Thinking for Collaborative Care. St. Louis: Elsevier Saunders. Mosby’s Med ical, Nursing, & Allied Health Dictionary (6th ed. ). St. Louis: Mosby, Inc. Zerwekh, J. , Claborn, J. C. & Gaglione, T. (2006). Mosby’s Pathophysiology Memory Notecards, Visual, Mnemonic, and Memory Aids for Nurses. St. Louis: Mosby, Inc.