King Leopold and the Belgian Congo Essay -- African History Essays

King Leopold and the Belgian Congo It is widely debated why exactly King Leopold decided to conquer the Congo, but the general consensus seems to be that it was out of the belief that â€Å"the highlands of the Congo may be as rich in gold as the mountains of the western slope of the American Continent† (Stead). In the mid-1870s, the King hired Henry Stanley, who was familiar with many parts of Africa, to help him go about conquering. During the following years Stanley stayed in Africa, talking various tribes into signing over their lands and rights. After this was completed the King officially took over the Congo, renaming it the Congo Free State. This was especially ironic because all natives of the country were either forced to give up their way of life in exchange for virtual slavery in the ivory trade, agriculture, or the rubber traffic, or die trying to escape fate. Leopold was undeterred by the amount of suffering and death in the Congo, brought on by his rule. Belgian soldiers and officials were known f or their cruelty in their methods to make, and then keep, Congo natives wo...

Diabetic Ketoacidosis

DIABETIC KETOACIDOSIS INTRODUCTION Diabetic ketoacidosis (DKA) is a very serious complication of diabetes mellitus, a metabolic disorder that is characterized by hyperglycemia, metabolic acidosis, and increased body ketone concentrations. The most common causes of DKA are infection and poor compliance with medication regimens. Other causes include undiagnosed diabetes, alcohol abuse, and a multitude of medical conditions such as cerebrovascular accident (CVA), complicated pregnancy, myocardial infarction, pancreatitis, and stress. Diabetic ketoacidosis is a complicated pathology.Early recognition of DKA, a good understanding of the pathological processes of DKA, and aggressive treatment are the keys to successful treatment. With good care, DKA can be managed and the patient will survive. OBJECTIVES When the student has finished studying this module, he/she will be able to: 1. Identify the correct definition of DKA. 2. Identify a basic function of insulin. 3. Identify the insulin dera ngements of types I and II diabetes. 4. Identify the basic cause of DKA. 5. Identify two specific causes of DKA. 6. Identify the two pathogenic mechanisms that produce the signs/symptoms of DKA. . Identify metabolic consequences of increased hormone concentrations in DKA. 8. Identify the criteria used to diagnose DKA. 9. Identify common signs and symptoms of DKA. 10. Identify laboratory abnormalities seen in DKA. 11. Identify complications of DKA. 12. Identify the three most important therapies for treating DKA. 13. Identify the correct roles of sodium bicarbonate and phosphate in treating DKA. 14. Identify an important rule for using potassium replacement in DKA. 15. Identify an important rule for switching from IV to subcutaneous insulin.EPIDEMIOLOGY Most cases of DKA are seen in patients with type I diabetes, but approximately 10%-30% of all cases of DKA occur in patients with type II diabetes. 1 The incidence of DKA appears to be rising, and this may not be related to the well p ublicized increase in the incidence of diabetes that has become a serious public health problem. 2 Diabetic ketoacidosis accounts for 50% of all diabetes-related admissions in young people with the disease, and DKA is the most common cause of diabetes-related death in children and adolescents with type I diabetes. Diabetic ketoacidosis is much more common in children than in adults, it is more common in women than in men, and it is more common in Caucasians. 4 The exact incidence of death from DKA is not known, but it has been estimated to be between 1%-10%. 5 Survival depends on the severity of the case, the age of the patient, the presence/absence of certain medical conditions, and how quickly DKA is recognized and how effectively it is treated. If the condition is promptly diagnosed and properly treated, the mortality rate can be 250 mg/dL) metabolic acidosis (blood pH ? . 30) and an elevated level of serum ketones (> 5 mEq/L) and/or ketones in the urine. 11 Patients will also ha ve an anion gap (Na+ – Cl- + HCO3-), an elevated blood urea nitrogen (BUN), hyponatremia, hyperkalemia, and the serum amylase may be elevated. The total body phosphate level may be low but the serum level may be normal or elevated. At this time, there is no universally agreed upon consensus for the diagnostic criteria of DKA, and some sources feel that an anion gap > 10-12 mEq/L and serum bicarbonate (HCO3) ? 8 mEq/L should be part of the criteria. Learning Break: Some authors feel that most important test for diagnosing DKA is total blood ketone concentration. 12,13 The acidosis and hyperglycemia of DKA and the electrolyte changes that are so commonly seen in DKA are closely related. The shift in metabolism and the high concentration of acidic ketones seen in cases of DKA produces a metabolic acidosis. Acidosis and insulin deficiency causes potassium to shift from the intracellular space to the extracellular space and serum hyperkalemia is common.However, the osmotic diuresi s that is characteristic of DKA causes potassium to be excreted in the urine; although the serum potassium level may be high, the patient may be profoundly depleted. Sodium and phosphate are also excreted by the osmotic diuresis, and hyponatremia is common. However, the serum phosphate level is often falsely normal or falsely elevated because phosphate, like potassium, is excreted in the urine but acidosis induces phosphate to move from the intracellular space to the extracellular space.The serum level might be normal, but the actual total body load is low. Learning Break: The serum glucose can be very elevated in severe cases of DKA. However, serum glucose can be close to normal, and approximately 10% of patients with DKA will be euglycemic with a serum glucose ? 250 mg/dL. 14 COMPLICATIONS OF DIABETIC KETOACIDOSIS Patients who have diabetic ketoacidosis that is promptly recognized and promptly and correctly treated should survive. The complications of DKA are complications of trea tment and cerebral edema.Treatment complications are hypoglycemia, hyperkalemia, and occasionally pulmonary edema. These can be avoided by using low-dose insulin therapy, monitoring blood glucose very closely, and by carefully managing fluid replacement. Cerebral edema is a very serious complication of DKA. It occurs in approximately 1% of all children with DKA, but the mortality rate and the rate of neurological sequelae for these children have both been reported to be 21%, and the mortality rate and rate of sequelae can be as high as 24% and 26% respectively15,16 Adults with DKA rarely develop cerebral edema. 7 Signs and symptoms include mental status changes, bradycardia, seizures, abnormal response to pain, and decorticate and decerebrate posturing. TREATMENT FOR DIABETIC KETOACIDOSIS The most important treatments for DKA are fluid replacement, insulin therapy, and correcting electrolyte balances. Obtain baseline serum electrolytes, BUN, creatinine, serum glucose, an arterial or venous blood gas (either one is appropriate), a complete blood count, an ECG, and a CXR. Consider other laboratory studies if DKA is thought to be caused by an underlying disease. Fluid replacement: Fluid replacement will replace the fluid deficit, help decrease the blood glucose level, and maintain renal function. If the patient is severely hypovolemic, give 1 liter of 0. 9% sodium chloride over 30 minutes. If the patient is mildly dehydrated, check the serum sodium. If it is normal or high, give 0. 45% sodium chloride IV at a rate of 250-500 mL/h. If the serum sodium is low, give 0. 9% sodium chloride IV at a rate of 15-20 mL/kg per hour. Once the blood glucose is approximately 200 mg/dL, a solution of % dextrose with 0. 45% sodium chloride can be used. 18Learning Break: In the first hour of treating a patient with DKA, fluid replacement is more important than insulin therapy and should take precedent. 19,20 †¢ Insulin therapy: Insulin is a critical part – perhaps the critical part – of the treatment of DKA. It can be given as an IV infusion or frequent subcutaneous injections: they are equally effective. Most clinicians prefer the IV route as the onset of action is quicker and the half-life is shorter with the IV route than the onset of action of and half-life of insulin given subcutaneously: because of that, therapy can be closely monitored.The American Diabetes Association recommends giving an initial IV bolus of regular insulin, 0. 1 U/kg. (Note: If the serum potassium is < 3. 3 mEq/L insulin should not be given). Following the bolus dose, start a continuous IV infusion of regular insulin at a rate of 0. 1 U/kg/h. An alternative is to omit the bolus dose and start a continuous IV infusion of regular insulin at a rate of 0. 14 U/kg/h. If the serum glucose does not decrease by 10% within an hour of starting the insulin, give 0. 14 U/kg as a bolus dose, then continue the IV infusion.Once the serum glucose is < 200 mg/dL, reduce the insul in dose to 0. 02-0. 05 U/kg/h or give subcutaneous doses of rapid-acting insulin, 0. 1 U/kg every two hours. The goal at this point is to keep the serum glucose between 150-200 mg/dL. 21 0. 1 U/kg IV bolus v 0. 1 U/kg/hr * v When serum glucose < 200 mg/dL, decrease infusion to 0. 02-0. 05 U/kg/h v Keep serum glucose between 150-200 mg/dL until DKA resolves * If serum glucose doesn’t v by at least 10% in the 1st hour of insulin therapy, give an IV bolus of 0. 14 U/kg and adjust the infusion. Correcting electrolyte imbalances: If the serum potassium is < 3. 3 mEq/L, do not start insulin therapy and give 20-30 mEq of potassium per hour until the serum level is >3. 3 mEq/L. Fluid replacement and insulin therapy lower blood sugar and correct acidosis and they also move potassium into the cells. If the serum potassium is < 3. 3 mEq/L, serious arrhythmias could result. Once the hypokalemia has been corrected, insulin therapy can be started, and 20-30 mEq of potassium can be added to each liter of IV solution in order to maintain a serum potassium level between 4. -5. 0 mEq/L. Learning Break: Serum glucose and serum potassium should be checked every hour until the patient is stable. Two other considerations for treatment are administering sodium bicarbonate to help correct the acidosis and replacing phosphate losses. Using sodium bicarbonate is controversial. Severe acidosis can decrease myocardial contractility, can cause and prolong coma, shifts the oxyhemoglobin dissociation curve to the right, etc. , so correcting an acidosis would seem important. However, there are risks involved (e. g. making body hypokalemia worse, cerebral edema), there are many clinical studies that indicate sodium bicarbonate therapy is not effective for patients with DKA, and for many patients the acidosis will correct with fluids and insulin and because they have adequate stores of bicarbonate. 22 The use of sodium bicarbonate should not be standard care for DKA. However, the Americ an Diabetes Association does recommend that if a patient has a severe acidosis with a pH < 6. 9, the patent should receive 100 mEq of NaHCO3 in 400 mL IV fluid along with 20 mEq of potassium chloride; this should be infused at 200 mL/h.Repeat this every two hours until the pH is ? 7. 0. 23 Low phosphate levels will usually correct as the hyperglycemia and acidosis are corrected, and phosphate replacement is not standard care for DKA. However, if the phosphate is very low – < 1. 0 mg/dL – or the patient has anemia, cardiac disease, or hypoxia, 20-30 mEq of phosphate can be given. 24,25 SWITCHING TO SUBCUTANEOUS INSULIN Diabetic ketoacidosis is considered to be resolved when the blood glucose is < 200 mg/dL and at least two of these laboratory values are present: a venous pH > 7. 3, an anion gap < 12 mEq/L, and a serum bicarbonate level > 15. mEq/L. 26 If these laboratory values are present and the patient can eat, it is safe to start subcutaneous insulin. Intravenous in sulin should be continued for one to two hours after the first dose of subcutaneous insulin has been given. If this is not done, hyperglycemia and ketosis may recur. NURSING CARE, PREVENTION AND EDUCATION When providing care for a patient in the acute phase of DKA, the nurse should focus on hydration status/fluid replacement, monitoring of acid-base status, serum glucose, and serum electrolytes, close observation of the patient’s neurological status, and vital signs.Once a case of DKA has resolved it is important to know why it happened. Infections, medical conditions, and drugs are common causes of DKA. However, one of the most important causes of DKA is patient non-compliance with diabetic treatment regimens: patients do not take their medication or do not take them properly, they fail to follow their prescribed diet and lifestyle plans, and they do not or cannot understand the basics of self-care and prevention as they relate to diabetes.If non-compliance was the cause of a particular case of DKA, it is very important to determine why the non-compliance occurred, and there many possible reasons. Some of the more common ones are: †¢ Poor access to medical care: The patient may not have access to health care information, may not have easy access to a physician, clinic, etc. , may not have or not know how to use community or public access health care resources. The patient may not have money for medications. Lack of information: The patient may have a poor understanding of diabetes, and the patient may not understand the treatment regimens that have been prescribed. Lack of information can be damaging in many ways. If the patient doesn’t understand the disease of diabetes, he/she might be less willing to comply with lifestyle and diet restrictions and less willing to take medications. The patient would not recognize possible warning signals of DKA. †¢ Emotional issues: For many people, diabetes requires lifestyle changes that they may n ot be willing to emotionally accept.Learning Break: Although it may be said that non-compliance happens when the patient fails to provide good self-care, the word fail typically has a negative connotation. Also, when many people hear the term non-compliance, they think of a person willfully failing to do what he/she knows is best. However, there are many cases of non-compliance that happen because the patient has not been properly educated, or doesn’t have or doesn’t know how to get the resources he/she needs.So when it has been determined that non-compliance was the cause of a particular case of DKA, interview the patient and find out a) the emotional impact of diabetes on the patient’s life, b) how much he/she knows about the disease and the treatments, and c) what financial, medical, personal, and social resources the patient has available for self-treatment. Some of these issues must be addressed by social workers, psychologists, or the patient’s phys ician. However, nurses have a primary role in supporting and educating patients who have had an incident of DKA related to on-compliance. The nurse will often be the first person to find out that the patient did not seek medical attention for an infection because of financial concerns, or due to inability to each a physician, or because of a lack of understanding of the implications of infection in diabetes. The nurse must then discuss making the appropriate referrals and then set up a teaching plan. Some of the nursing diagnoses that might apply in theses situations would be imbalanced nutrition, noncompliance, knowledge deficient, and risk for injury. SUMMARY Diabetic ketoacidosis is a metabolic disorder characterized by hyperglycemia, metabolic acidosis, and elevated body ketone concentrations. †¢ The basic cause of DKA is insulin deficiency, absolute or relative. The insulin deficiency most often occurs because of infection or non-compliance with diabetic treatment regimens . †¢ Excess hormone concentration and a metabolic shift are the pathogenic mechanisms that cause the signs and symptoms of DKA. †¢ The hormone concentrations cause hyperglycemia, and the metabolic shift causes acidosis and elevated body ketones. The basic diagnostic criteria for DKA are a blood glucose > 250 mg/dL, a serum pH < 7. 3, and elevated serum and/or urine ketone concentrations. †¢ Other important criteria are an anion gap > 10-12 mEq/L and serum bicarbonate (HCO3) ? 18 mEq/L. †¢ Hyperkalemia and hyponatremia are common in DKA. Hypophosphatemia can be seen. However, the total body load of potassium and phosphate is often low. †¢ Common signs and symptoms include dehydration, mental status changes, polydipsia, polyuria, vomiting, weakness, and weight loss. †¢ Complications of DKA include complications caused by treatment and cerebral edema. Treatment for DKA should focus on fluid replacement, insulin therapy, and correcting electrolyte abnormali ties. Sodium bicarbonate is not standard care. †¢ If DKA if promptly recognized and properly an aggressively treated, patients should survive. REFERENCES 1. Wilson JF. In the clinic: Diabetic ketoacidosis. Annals of Internal Medicine. 2010; 152:ITC-1-ITC-16. 2. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. 3. Wolfsdorf J, Glaser N, Sperling MA.Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:1150-1159. 4. Hamdy O. Diabetic ketoacidosis. eMedicine. September 9, 2009. Available at: http://emedicine. medscape. com/article/118361. Accessed December 24, 2010. 5. Hamdy O. Diabetic ketoacidosis. eMedicine. September 9, 2009. Available at: http://emedicine. medscape. com/article/118361. Accessed December 24, 2010, 6. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. . Rucker DW. Diabetic ketoacidosis. eMedicine. June 4, 2010. Available at: http://emedcine. medscape. com/article/766275. Accessed December 24, 2010. 8. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. 9. Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001;24:131-153. 10. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. 11. Hamdy O.Diabetic ketoacidosis. eMedicine. September 9, 2009. Available at: http://emedicine. medscape. com/article/118361. Accessed December 24, 2010. 12. Wilson JF. In the clinic: Diabetic ketoacidosis. Annals of Internal Medicine. 2010; 152:ITC-1-ITC-16. 13. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes . Diabetes Care. 2009;32:1335-1343. 14. Miles JM, Gehrich JE. Glucose and ketone body kinetics in diabetic ketoacidosis. Clinical Endocrinology & Metabolism. 1983;1:303-319. 15. Glaser NS, Wooton-Gorges SL, Buonocore MH, Marcin JP, Rewers A, Strain J. et al. Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatric Diabetes. 2006;7:75-80. 16. Wolfsdorf J, Glaser N, Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:1150-1159. 17. Haringhuizen A, Tjan DHT, Grool A, van Vugt R, van Zanten ARH. Fatal cerebral oedema in adult diabetic ketoacidosis. The Netherlands Journal of Medicine. 2010;68:35-37. 18. Wilson JF. In the clinic: Diabetic ketoacidosis. Annals of Internal Medicine. 2010; 152:ITC-1-ITC-16. 19.Goyal N, Miller JB, Sankey SS, Mossallam U. Utility of initial bolus insulin in treatment of diabetic ketoacidosis. Journal of Emergency Medicin e. 2010;38:422-427. 20. Rucker DW. Diabetic ketoacidosis. eMedicine. June 4, 2010. Available at: http://emedcine. medscape. com/article/766275. Accessed December 24, 2010. 21. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. 22. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. 23.Wilson JF. In the clinic: Diabetic ketoacidosis. Annals of Internal Medicine. 2010; 152:ITC-1-ITC-16. 24. Kitabchi AE, Umpierrez GE, Fisher JN, Murphy NB, Stentz FB. Thirty years of personal experience in hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Journal of Clinical Endocrinology & Metabolism. 2008;93:1541-1552. 25. Wilson JF. In the clinic: Diabetic ketoacidosis. Annals of Internal Medicine. 2010; 152:ITC-1-ITC-16. 26. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343.

Brown v. Board of Education of Topeka - Free Essay Example

Sample details Pages: 3 Words: 868 Downloads: 10 Date added: 2019/10/31 Category History Essay Level High school Tags: Brown v Board of Education Essay Did you like this example? Brown v. Board of Education of Topeka (1954) Introduction:   Ã‚  Ã‚   Brown v. Board of education consists of the Oliver Brown, whose purpose was to have the blacks and whites to attend to the same school. Don’t waste time! Our writers will create an original "Brown v. Board of Education of Topeka" essay for you Create order In this case Oliver Brown was the defendant due to him fighting for his kids right not being able to attend a white colored school. The plaintiff was The Kansas board of Education. Representing Topeka Board of education was Lester Goodell.Oliver Brown was represented by the members of the NAACP -Robert L.Carter. Oliver Brown was both the plaintiff and the defendant. Objective: The objective of this case study is to give a information about this case. The plaintiffs, who defended them, who represented the defendant. Why this was all caused, how this was all caused.Who was all involved in the case. Who were the judge and attorneys involved in the case. Background:  Ã‚  Ã‚     Ã‚  Ã‚   Before 1954 African Americans were always treated differently. They have always considered second class citizens. At that time many children had to go to schools farther away from their home due to the schools being segregated. Even though many African American children lived closer to an all whites school, they would not be allowed to go in due to the color of their skin. Due to the fourteenth amendment Equal protection laws the children were not being treated equally. Defendant:   Ã‚  Ã‚   The defendants were the African american families who were not being treated equally due to the color of their skin. They would constantly be looked down upon and were unfair to them. They were constantly suffering due to how they were being treated due to their color of their skin. Many families were fighting so they could be treated equally, so their children would be able to attend to a whites school due to the fact that it was much closer than their segregated school. At the time the defendants were at fault due to segregation being legal, and what they were doing was illegal. Plaintiff:   Ã‚  Ã‚   In this case the Kansas Board of Education was the plaintiff. Many african american families felt like the schools of their children was not as good and did not provide as much like they did in all whites school. However many families tried to enroll their kids into an all whites school but were rejected because that was not allowed. Although they said many times they all schools were provided equally, however Kansas board of education filed a lawsuit against them. The Judges:   Ã‚  Ã‚   The judges that were included in the ase were Arthur Mellott, Delmas Hill and Walter Huxman. Walter Huxman who was in favor with Kansas Board of Education. Attorneys:   Ã‚  Ã‚   Topeka Board of education was represented by Lesser Goodell. Oliver Brown was represented by attorneys of NAACP and Robert Carter. They were questioned and they had to answer the question one out of the three judges did not agree with them. Verdict Verbatim: To separate them from others of similar age and qualifications solely because of their race generates a feeling of inferiority as to their status in the community that may affect their hearts and minds in a way unlikely ever be undone. -Chef of justice Earl Warren. Defendant:   Ã‚  Ã‚   The defendants were the ones who supported segregation everywhere and would be bothered by African American people. They would not allow African Americans to enroll to their school or anything in that matter. Plaintiff:   Ã‚  Ã‚   In this case the plaintiff were the people who refused against segregation which included Oliver Brown and the families that were involved in that case.   Attorneys:   Ã‚  Ã‚   Everything continued the same the same people were represented by whom they were originally represented. Oliver Brown had strong viewpoint and strong ideas. Verdict: Segregation of white and colored children in public schools has a detrimental effect upon the colored children. The impact is the greater when it has the sanction of the law, for the policy of separating the races is usually interpreted as denotation the inferiority of the nero group..Any language is contrary to this finding rejected. We conclude that in the field of public education the doctrine of separate but equal has no place. Separate educational facilities are inherently unequal. Earl Warren, Chief Justice of the U.S. Supreme Court. Critique:   Ã‚  Ã‚   The segregation laws kept many people from doing many things. African American people should not be considered second class citizens. African Americans were not being given the same opportunities white people died due to their color of their skin. In order to progress and achieve more in this world is if everyone is treated equally and be kind to each other no matter what. No matter if somebody has a different viewpoint (religion, ethnicity, ideas) Conclusion:   Ã‚  Ã‚   Not only in this case study did i learn more about out history in the past, but it made me open my eyes to a lot of things. In this case study African Americans stood up for them, their children and their future people so they can be treated equally. Many people came together to stop segregation until it was finally achieved. Although segregation was an awful law in the past, this is what made us, we can only learn from our mistakes.