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Question: While multicellularity gives organisms many advantages over single-celled organisms, it also poses numerous challenges. In a short essay,

Question:
While multicellularity gives organisms many advantages over single-celled organisms, it also poses
numerous challenges. In a short essay, describe TWO challenges of multicellularity, and explain how
a specific organism has overcome these difficulties.

ASSIGNMENT INSTRUCTIONS:
You must adhere to the following when preparing your essay. Failure to abide by these instructions will affect
your grade for this assignment.
A sample that illustrates how to correctly format your essay is located on pages 4-5 of this document.
1. Follow the submission instructions given in the next section (including how to name the file that you
will submit into the Blackboard Dropbox).
2. The assignment must be typed in 12-point font and double-spaced with one-inch margins.
3. Course number, assignment number, student name, student number, submission date plus word count
must be listed at the top of the first page.
4. The essay must have a title that relates to the content of your essay. Do not put this title on a separate
page.
5. Essay must be between 300 and 400 words. This word count may include in-text citations (e.g., Smith
et al., 2022) but must exclude the reference list at the end of your paper.
6. Submissions must use essay style. This means that the assignment must have a clear introductory
paragraph, one or more body paragraphs and a short concluding paragraph.
7. Sources should be scientific and scholarly (like textbooks and journal articles) and must be cited using
APA7 citation style.
8. Do not use direct quotations. Deductions will be given if direct quotes are used.
9. The essay requires at least two references, one of which may be the course textbook (please refer to
the requirements when citing your textbook under the heading “References” on page 6 of this
document). At least one reference must be a journal article. Primary and secondary sources are both
acceptable for this assignment.

Post 1 SP- Standards of care are known as the trusted practice

Post 1 SP-

Standards of care are known as the trusted practice of healthcare and remain the baseline for measuring quality care for nurses and other healthcare professionals alike (Ashton, 2019). For the past couple of years, sepsis has taken a forefront in healthcare and especially in the Emergency Department making it a newer standard of care.  With sepsis care, there are multiple lab tests and medications that are required to reduce the morbidity and mortality rates of sepsis. One lab test that has been more of a sepsis marker is Lactic Acid. Elevated lactate levels can identify tissue hypoperfusion and have become the driving force for early intervention therapy in septic shock (Ryoo & Kim, 2018). Lactate is a driving force in aerobic processes for multiple parts of the body including the neurologic system, cancer metabolism, immune system, wound healing, and ischemic injuries (Ryoo & Kim, 2018).  When the oxygen requirement exceeds the oxygen delivery or availability is when lactate levels become elevated due to the decreased metabolization of the lactate in the Krebs Cycle leading to tissue hypoxia and hyperlactatemia. Best practice shows improvement in patient outcomes and reduced mortality rates when early guided treatment is based upon lactate levels (Ryoo & Kim, 2018). To improve lactate levels the treatment plan includes adequate volume resuscitation using inotropes, blood transfusion and providing adequate oxygen supply (Ryoo & Kim, 2018).

References

Ashton, K. C. (2019). Standards of care and standards of practice. The Journal of Legal Nurse Consulting, (30)4, 10-13. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=693622ed-e677-4850-922c-86c02dd536f5redis

Ryoo, S. M., & Kim, W. Y. (2018). Clinical applications of lactate testing in patients with sepsis and septic shock. Journal of Emergency and Critical Care Medicine, 2:14, 1-10. https://jeccm.amegroups.com/article/view/4083/pdf

POST2

For my practicum experience, I have chosen to focus on palliative care. Because I have worked with seniors for nearly twenty years and in hospice for the last eight years, during this experience, there has not been any test or medications that are completely new to me. However, the lab test that I’ll be revieing is the albumin. This is a lab test that is looked at in both palliative care and hospice as an indicator of mortality. While I am very familiar with the test, and look at these lab results often, I have never researched why it is an indicator of mortality.

As a quick review, albumin is a protein that is produced in the liver. Some of its main functions are maintaining oncotic pressure, maintaining microvascular permeability and preventing platelet aggregation (Akiroy et al., 2017). In my experience, those with severe protein calorie malnutrition, heart failure, renal disease, liver failure or various malignancies are likely to have hypoalbuminemia and are usually appropriate for hospice services. According to Wang et al. (2017), in healthy individuals, albumin synthesis is not a high priority for the body because synthesis will take place as long as there is proper nourishment, however, when faced with poor nutrition, inflammation, acute trauma, or chronic disease hypoalbuminemia can be detrimental. The patient is at increased risk for infection, wounds and death. For example, research on patients post cerebral vascular accident, who are malnourished, have an increased incidence of death, cardiovascular events, and infectious diseases verses those with normal albumin level even after rehabilitation has been completed (Maruyama et al., 2018).

 

Akirov,A., Masri-Iraqi, H.,  Atamna, H., Shimon, I. (2017). Low albumin levels are associated with mortality risk in hospitalized patients. American Journal of Medicine, 130(12). https://doi.org/10.1016/j.amjmed.2017.07.020

Maruyama, K., Nakagawa, N., Koyama, S., Maruyama, J., & Hasebe, N. (2018). Malnutrition increases the incidence of death, cardiovascular events, and infections in patients with stroke after rehabilitation. Journal of Stroke and Cerebrovascular Diseases, 27(3), 716–723. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.10.002

Wang, X., Han, Q., Wang, T., & Tang, W. (2020). Serum albumin changes and mortality risk of peritoneal dialysis patients. International Urology & Nephrology, 52(3), 565–571. https://doi.org/10.1007/s11255-020-02389-y

Disproved Scientific Theories The disproved theory I will be writing about is

Question: While multicellularity gives organisms many advantages over single-celled organisms, it also poses numerous challenges. In a short essay, Writing Assignment Help Disproved Scientific Theories

The disproved theory I will be writing about is the Einstein Static or Stationary Universe. Albert Einstein came up with the theory in the year 1917, just after completing the theory of relativity. This theory is about a relativistic model of the universe in which the universe is both spatially and temporally infinite and space is neither expanding nor contracting. This model of the universe became known as the Einstein World or Einstein’s static universe.

People believed in Einstein static universe for 14 years until the year 1931. In his seminal Cosmological Considerations paper of 1917, Einstein showed that general relativity could indeed give a consistent model of the static universe. However, two assumptions were necessary. Firstly, the universe was of closed spatial geometry like a sphere and had no beginning or end. Secondly, a consistent solution necessitated the introduction of a new term to the field equations of relativity. Some regarded the new term, known as the cosmological constant, as something of a fudge factor and claimed that it marred the symmetry and simplicity of the original field equations. However, general relativity certainly allowed the term; indeed, it is a little-known fact that Einstein had noted the possibility of such an extension to the field equations in his original exposition of 1916. Now the cosmological constant found an important application because it allowed a model of the universe that was consistent with Einstein’s views on the relativity of inertia.

Einstein’s Cosmological Considerations paper is a fascinating read as it contains a discussion of his views of the limitations of Newtonian cosmology and a description of his long path to a satisfactory relativistic model of the universe.

Diversity & Inclusion Module (Collaboration) Activity: Ted Talk What is the central

Diversity & Inclusion Module (Collaboration)

Activity: Ted Talk

What is the central argument of Adichie’s talk?

What is the “single story” folks typically associate with Adichie and those from the
continent of Africa, more broadly?

How have people misunderstood your story? In other words, what might others assume is
your “single story,” and how does that misrepresent the complexity of who you are?

How have you misunderstood others (specific people, racial or religious groups, etc.)?  What “single story” did/do you associate with that group?

How might you avoid falling into the trap of the “single story” in the future?

Discussion

Part 1- Share an experience in your life where you feel you did not “fit in.” Why did you feel this way? Do you feel there was something about your identity that contributed to others making you feel unwelcome?

Part 2- Now think of a situation in which you may have felt like you would not feel welcome, but in fact did. What, specifically, occurred that made you feel welcome and included? Was there a single person most responsible for fostering that environment of inclusivity? If so, who and why?

Reflection

When did you first become aware of racial, gender, and sexual differences?

Describe a time in which you witnessed discrimination on the basis of race, gender, or
sexuality.

Describe a time in which you feel you were discriminated against.

How much interaction do you have with folks who’s racial, gender and sexual identity
differ from yours? Has that remained more or less constant throughout your life?

Melinda Diabetes While there are differences in types of diabetes, the core

Melinda

Diabetes

While there are differences in types of diabetes, the core dysfunction of the body’s inability to properly use or produce insulin in the body is the basis. In type I diabetes (previously called juvenile diabetes), the pancreatic beta cells are attacked by an auto-immune response which inhibits the actual production of insulin (McCance et al., 2019). Type I usually is diagnosed when the body is hyperglycemic and often causes diabetic ketoacidosis, which can be life-threatening. Type II diabetes used to effect only adults but is occurring much more frequently in obese children. In Type II diabetes there is a dysfunction of the bodies ability to effectively use the insulin it produces. Type II diabetics usually produce some amount of insulin, however there is insulin resistance and hyperglycemia that results from this. While Type I is more likely related to genetics and has some environmental triggers and relation, Type II is thought to be have some genetic factor and then more linked to the environmental influences such as hypertension, diet, obesity, and physical inactivity. Gestational diabetes occurs in pregnancy when the body has the inability to properly utilize insulin after pregnancy occurs. Gestational diabetes has both a decreased production of insulin from the pancreas, as well as increased insulin resistance.

Drug Description, Preparation and Administration

In this discussion post, we will take a closer look at Type II diabetes and the use of metformin in controlling glucose levels. Metformin has three main effects on the body. Rosenthal et al. explains these three effects as inhibiting glucose production in the liver, reducing glucose absorption in the GI tract, and third, it increases glucose uptake in fat and skeletal muscle tissue (2021). All three of these mechanisms drive lowering glucose levels in the blood and reducing instances of hyperglycemia for the patient, which ultimately lead to worse long-term outcomes. Metformin is used in conjunction with lifestyle changes in patients with Type II diabetes and can only provide partial glycemic control in many of these patients.

            Metformin is usually prepared in doses starting at 500mg and going up to 850 mg and 1000 mg tablets. There can be some gastrointestinal side effects so it is often started at 500 mg and if needed, the dose can be incrementally increased until the desired effect is reached. The medication should be taken with a meal in order to reduce the possible GI discomfort (Sanche-Rangel et al., 2017). It is also recommended that metformin is stored at room temperature and expiration dates on bottles should always be followed.

Dietary considerations

            Diet is incredibly important in the control of Type II diabetes and it important for these diabetic patients to work closely with their providers to make the proper lifestyle changes. In the use of metformin, it is important to make sure that patients are eating a normal diet when they take the medication. Nasari et al., discusses that metformin does not usually cause hypoglycemia but it can occur if a patient stops eating while on the medication (2014). If a patient continues there diet as discussed with their providers and are eating regularly, this should not be a problem.

Short-term and long-term impact

            The most common short-term impacts of metformin use on the diabetic patient have to do with GI discomfort. Some patients have instances of nausea and vomiting and in some cases, it can be enough to discomfort to discontinue the medication. Metformin can also cause malabsorption of some vitamins. Lastly, metformin can cause hypoglycemia in rare cases such as discussed in the dietary consideration.

            The long-term effects and impact of metformin are the most important and are the actual desired effect of the drug. Metformin’s aim is to reduce instances of hypoglycemia in the diabetic patient. Instances of hypoglycemia lead to worse outcomes including atherosclerotic cardiovascular disease, hypertension, dyslipidemia, and kidney disease, among many others (Davies et al., 2018). There are not many known negative effects on the long-term use of metformin, however with so many patients effected with Type II diabetes there is constant research and it is necessary to continually research the drugs our patients are using.

 

 

References

Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing,

P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018). Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). DIABETOLOGIA, 61(12), 2461–2498. https://doi.org/10.1007/s00125-018-4729-5

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in

adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Nasri, H., & Rafieian-Kopaei, M. (2014). Metformin: Current knowledge. Journal of research in

medical sciences : the official journal of Isfahan University of Medical Sciences, 19(7), 658–664.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice

nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Sanchez-Rangel, E., & Inzucchi, S. E. (2017). Metformin: clinical use in type 2

diabetes. Diabetologia, 60(9), 1586–1593. https://doi.org/10.1007/s00125-017-4336-x

cordelia

Diabetes Mellitus and its Treatment

            Diabetes mellitus is a chronic medical condition affecting the metabolic function of the body characterized by altered glucose conversion into energy for cellular utilization, insulin resistance by the cells, and anomalies in insulin secretion (Chaudhary &Tyagi, 2018). The disorder can be diagnosed at any age and is usually diagnosed by testing the random blood sugars and fasting blood glucose. However, a more accurate way of diagnosing DM is by measuring glycosylated hemoglobin levels (HbA1C).

            It is divided into four main types: Type 1/juvenile DM, Type 2 DM, and gestational DM. Type 1/juvenile DM mainly occurs in the under-ten population resulting from autoimmune dysfunction which activates CD4, CD8 T cells, and macrophages which infiltrate the pancreas leading to chronic inflammation, consequently causing destruction and death of the B-cells (Chaudhary &Tyagi, 2018). Type 2 DM is primarily hereditary and occurs due to the risk of old age, obesity, and lack of exercise, which results in high sugar due to the body’s inability to produce and utilize insulin. Individuals mainly present with symptoms such as fatigue, frequent infections, and prolonged wound healing, among others. Gestational DM usually occurs due to pregnancy, and its onset is during the gestation period due to high blood sugar.

Use of Metformin in Managing Type 2 DM

            I will choose to describe Type 2 DM. Metformin is a drug that is classified under biguanides in antidiabetic drugs. Biguanides are usually the first-choice drugs for Type 2 DM and are contraindicated in cases where it inhibits the liver’s glucose production and increases muscle tissue insulin sensitivity (Rosenthal &Burchum, 2021). Metformin is usually available in two oral preparations. The first is an initial adult dose as an immediate-release tablet, which is 500mg, taken orally once or twice daily, or 850mg can be taken daily. The first oral preparation is administered when a meal is taken to reduce gastrointestinal disturbance, and the dose is gradually increased every seven and; the purpose is to minimize the adverse GIT effects. The second preparation is the initial adult dose for extended release; the dosage taken is 500mg-1g once a day and is advisable to be administered during the evening meal. The dose is gradually reduced to minimize GIT upset (Rosenthal &Burchum, 2021). Metformin is contraindicated in cases whereby the individual has renal impairment with creatinine levels (>136mmol/l in males and >124mmol/l in females). Another contraindication in congestive heart failure requires pharmacological treatment, and individuals hypersensitive to metformin are also contraindicated from using it.

Short-term and Long-term Complications of Type 2 DM and the Effects of Treatment

Short-term Complications of Type 2 DM

            One of the short-term effects of Type 2 DM is Hyperosmolar Hyperglycemic Nonketotic Syndrome, a condition whereby blood glucose rises drastically. If not treated, it might lead to death. Another complication is hypoglycemia, a drop in blood glucose levels below the normal range of 11g/dl. It occurs due to the effect of insulin medications and might also be due to other medications such as salicylic acid(aspirin) and excessive alcohol consumption. The most obvious signs of hypoglycemia include increased heart rate, numbness and tingling sensation in the extremities, and confusion.

Long-term Complications of Type 2 DM

            Long-term complications usually develop after years of having the disease. Most of the long-term complications usually affect the blood vessels and cause damage to the organs of the body. Examples include microvascular complications, which are retinopathy, nephropathy, and diabetic neuropathy, and macrovascular complications, which affect the heart, brain, and blood vessels. Retinopathy is a condition that causes cataracts in the eyes, which can lead to vision loss. Diabetic neuropathy causes nerve damage due to damage to the small blood vessels that supply the nerve cells. Nephropathy is a condition that causes kidney damage when diabetes is not well controlled. This leads to impaired kidney function and may lead to heart failure.

Effects of Treatment  

            Despite the positive effects of metformin in treating Type 2 DM, side effects may also occur. The most common side effects involve the gastrointestinal system, including abdominal discomfort, decreased appetite, and nausea. Other less common effects are anxiety, blurred vision, dizziness, nervousness, and difficulty breathing. Individuals under the prescription of metformin must monitor vitamin B12 levels because it can lead to vitamin B12 deficiency (ADA,2018). They are recommended to monitor hematologic and renal system function. Finally, they should continually do fasting blood sugar tests and hemoglobin A1C in patients with stable blood glucose.

 

 

References

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes 2018. Diabetes care,  10.2337/dc18-S008

Chaudhary, N., & Tyagi, N. (2018). Diabetes mellitus: An Overview. International Journal of Research and Development in Pharmacy & Life Sciences, 7(4), 3030-3033.http://dx.doi.org/10.47583/ijpsrr.2021.v69i01.011

Rosenthal, L. D., & Burchum, J. R (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.) St. Louis, MO: Elsevier. https://evolve.elsevier.com/cs/product/9780323554954?role=student