International finance structure and IPE of international Debt Essay

International finance structure and IPE of international Debt - Essay Example The diagram also illustrates the law of demand. Fewer dollars will be demanded when the price of a dollar increases according to the law of demand. The chapter also provides appropriate examples, the Microsoft Vista example is very appropriate to understand how the exchange rate works in different countries. Interest rates also play a pivotal role in determining the value of a dollar. Business expectations also play a crucial role in determining the exchange rate, since Mexican Peso has been taken up as an example it is very important to also consider interest rates in Mexico and business expectations in Mexico. Capital gain is another subject that the chapter highlights. The business expectations in the United States are juxtaposed with the business expectations in Mexico. The demand part is initially presented in the chapter and the second part of the chapter comprehensively explains the supply side of the Dollar and how it relates to the Mexican economy. National income in the Uni ted States also plays a key role in the supply of the Dollar. ... same concept can be applied to different currencies and its exchange rate can easily be found out and in addition to this the factors affecting the exchange rate can also be found out. Foreign exchange rates are comprehensively explained in the following parts of chapter 7. Gold standard, Bretton Woods and floating exchange rate are the three most important exchange rate structures that have been used to determine the exchange rate. The Bretton Woods system of exchange was introduced in the year 1944 and the system was established in the Bretton Woods conference in New Hampshire. There is rapid growth and development taking place all across the globe, to make sure that everything goes on well, a system which should stabilize the growth is a must. This paper will throw light upon the advantages of the Bretton Woods system and it will also provide a comprehensive understanding of the Bretton Woods fixed exchange rate system. The system has very old roots, after the devastating World Wa r one all the countries wanted financial security to make sure that economic growth in the country takes place. The great depression in the 1929 was a result of the failure in the introduction of gold standard. Each and every currency intentionally deflated its currency in order to get high margin of profit from the exports which would decrease the deficit from the country’s economy. The same had an adverse affect on all the countries, it triggered off international deflation, and this majorly impacted many countries, mass unemployment increased, big enterprises were going bankrupt, global economy witnessed hyper inflation. There were talks held among the representatives of various countries to form a system which would bring stability with regard to the financial and economic well being

Reproductive Strategies in Birds

Reproductive Strategies in Birds Catherine Carrick Introduction Birds, like any other organism, constantly struggle to find a balance between the benefits of reproduction and the costs of reproductive effort expressed as adult mortality (RICKLEFS, 1977). As well as behavioural differences among species such as brood size, protection of young or the effort required for foraging, environmental factors influence avian reproductive strategies. This includes bionomics, for example; how efficiently a bird procures and utilizes available resources, and how it protects its investment (offspring). During the last 50 years it has become the consensus that reproduction and mortality rate among birds are directly proportional, and that the age of sexual maturity increases with adult survival rate (RICKLEFS, 2000), where reproduction rate is determined by the length of the breeding season, the clutch size, and nesting success. The evolution of optimum clutch size was one of the first studies conducted by David Lack (1947) where food supply directly influenced fecundity. Later studies showed that in most cases, birds with a longer life span such as albatrosses had decreased clutch sizes, postponed sexual maturity and decreased reproductive success due to greater parental investment and thus a greater risk of parental death. Environments are often unpredictable and birds such as the black kite (Milvus migrans) produces more offspring early on it life (SERGIO, 2010). Competition, resources and hazards change in such a way and often so rapidly that the kites would die before being able to reproduce if sexual maturity occurred much later. Life Histories When understanding reproductive strategies, is it important to understand what is meant by life history. It is the history of adaptations and genetic modifications of a population in response to changes in the environment. It is not to be confused with a life table, which shows the interactions of adaptations and genetic modifications with the environment. Genetic variation gives rise to an evolutionary response in the gene pool to variation in the environment. Changes in the environment tend to change the density and age structure among a population making the population either crash, or revert back to a state of equilibrium. Sex Ratio Aspects of birds lives can vary up to 10-fold among species with opposite life histories (RICKLEFS, 2000) and the theme of this evolution include several components. The first is sex ratios. Fishers principle states that when male births are less common, those male offspring have better mating potential than the female offspring and so the males have more offspring. This then means the genes for male procuring tendencies spread, male births become more common and a 1:1 sex ratio is approached (the equilibrium). This reduces again as being born male becomes less advantageous (Hamilton, 1967). A study by Neville et al (2008) showed the sex ratio of 298 nestlings from 81 nests of golden-winged warblers Vermivora chrysoptera to be approximately 50:50 (1:1). However, Daan et al (1996) observed some raptor species producing excess daughters early in the breeding season and males later in the season, whilst other species showed the opposite. The deviation may be explained by specific enviro nmental conditions having different consequential outcomes for male and female offspring (DAAN et al, 1996). Sexual Selection Males and females differ through sexual dimorphism and secondary sexual characters such as elaborate tail feathers. If there is heritable variation in a trait that affects the ability to obtain mates, then variants conducive to success will become more common over time. Peahens select for male peacocks with the largest most elaborate tail feathers, and so this character is genetically passed on and becomes more common. Access to mates is a limiting factor for males and it was predicted that sexual selection will be a stronger force in the evolution of males than females (BATEMAN, 1948). This leads to stronger competition over mates in males and means that females should be choosy as they invest heavily in reproduction, yet another reason why males have large plumage to advertise to females. There are two theories as to why a female would choose a male with costly characters. Firstly is the sexy sons theory where cost arises as the end product of a runaway process. Secondly is the go od genes theory where females choose mates with good genes to maximise viability of there offspring (TRIVERS, 1972). For example, those peacocks with the brightest, largest and most elaborate plumage indicate to a female their probable resistance to parasites. Parental investment This can be described as any parental interactions with their offspring that increases the offspring survival rate, at the cost of the parents ability to invest in other offspring (TRIVERS 1972). Social monogamy with biparental care (BURELY, JOHNSON, 1992) is common among avian species. However, this has evolved from a very  different diapsid lineage in the fact that most extant and extinct diapsids show promiscuity and mainly lack parental care (with exceptions like crocodilians). Fig. 2 shows the stages of evolution from limited parental care in the basal archosaur leading to increased biparental care and ultimate monogamy among extant avian species. In contrast, social parasitism can avoid the risks of parental investment as seen in North American cuckoos (Coccyzus sp.) where the cuckoo lays its eggs in a hosts nest and the host incubates and raises the parasitic cuckoo chicks. Parent-offspring conflict The conflict is at its peak during the parental care period. It is loosely divided into intrabrood conflict where the offspring favour different division on parental investment that that preferred by the parent (KILNER, 2007) and interbrood conflict where the demands made by the offspring are too great that the parent withholds investment for future reproduction. An example is given in a study by Stamps et al (1985) on budgerigars (Melopsittacus undulates) where in female-fed families the parent controlled food allocation as they did not favour begging, whereas, in male-fed families the offspring had the greatest control, as the male parents were susceptible to allocating food to those who begged. Optimization in a Variable Environment D. Cohen (1966, 1968) reached the conclusion that fluctuating environments always favour greater reproduction, whereas constant environments select for small litters (SHAFFER, 1974). A case study by Jetz et al (2008) examined clutch size from 5290 avian species worldwide and correlated the environmental influences with the comparative approach (the relation of clutch size to other biological traits) in one analysis. It showed conclusive evidence that backed Cohens theory. For example, avian species in more stable seasonal environments had larger clutch sizes than those of tropical birds where the climate changes unpredictably and rapidly. Nest predation Prolonged incubation and nestling periods increase the probability that those nests will attract predators. The opposite can be said for minimal incubation and nestling periods. Therefore it can be assumed that those species with larger clutch sizes, prolonged incubation or nestling periods have adopted and evolved strategies to evade predation. For example, Killdeer (Charadrius vociferous) eggs and chicks are extremely well camouflaged (Fig. 3). Niko Tinbergen (1967) found that in the case of the black-headed gull (Larus ridibundus), the adult would remove the eggshell a short time after its chick had hatched, and place it away from the nest. This meant leaving the chick alone momentarily, but the advantage of removing the white, un-camoflaged egg shell outweighed the cost of cannibalism of the chick from neighbouring gulls. This behaviour is heritable among all black-headed gulls. Birds that evolve in areas with few or no predators should then exhibit larger clutch sizes, prolonged incubation and nestling periods. This is seen in island species that have had time to evolve in the absence of predators. However, a study preformed by Trevelyan and Read (1989) showed no significant differences in reproductive strategies between mainland Australia and New Zealand species. Trevelyan and Read interpreted these observations to be due to the arrival of humans, stimulating reproductive strategies similar to those on the main land. Conclusion Birds expend a great deal of energy providing parental care, breeding and courtship, whether or not the offspring are precocial (an advanced state if development) or altricial (completely dependant on the parent/s). It is clear that productivity of breeding is intrinsically linked to an avian life span and environmental factors which constantly encroach on avian fecundity and mortality. Of the 10,000 known extant avian species, each has developed a unique reproductive strategy, whether its be elaborate plumage to attract a mate as seen in tropical birds (genetic); removing egg shells to avoid cannibalism of offspring (behavioural); or laying a large clutch to ensure survival of the next generation in an erratically changing environment.

Health Professions :: College Admissions Essays

Health Professions At age ten, I left everything behind in China to start a new life with my parents in United States. It was not long before I realized that I was, in many ways, different from all the other kids in school. Gradually, I became less confident and more isolated. One day in the schoolyard, while I was playing hopscotch alone, a girl named Becca walked up to me and asked if she could join in. Although we had difficulty understanding one another's speech, we had no problem communicating through gestures and expressions. We soon realized that we had different ways of playing hopscotch. I watched her way and she watched mine; presently we came up with a brand new version of the game. Others soon joined us, and I found myself playing and laughing with kids whom I had thought I had nothing in common with. I have learned so much from Becca, but most of all I learned to not be afraid to build relationships with people who differ from me. Over the years, I have tried to live by this rule, and, as a result, have enjoyed many memorable and enriching relationships which have contributed to my desire to work with others in the practice of medicine. One such relationship is with a woman named Jeanette. Our relationship began when I became Jeanette's reader through the Pittsburgh Vision Center, where I work as a volunteer. Before meeting Jeanette, I had never interacted with a blind person. At our first meeting, she was excited to tell me about the new computer she had just purchased and a movie that she had recently seen, making no reference to her blindness. I soon forgot that she was blind myself. "Did you see that blue jay that just landed on the tree outside?" I blurted. There was a moment of awkwardness, as I tried desperately to come up with a way to explain my thoughtlessness. Jeanette saved me by requesting that I describe the scene to her. As I did so, a smile appeared on her face, and she responded, "I see it now." Later, it occurred to me that just as Jeanette had benefited from my way of perceiving the world, I could benefit form her way of "seeing" as well. For example, I have jogged in the park for years, but until

CIPD Ass Member Criteria Essay

What it means to be an Associate Member of CIPD The Associate Member applies their specialist skills and knowledge in the context of the organisation’s structure, culture and direction, by: providing support for human resources (HR) leaders and managers as they work to deliver a range of HR processes in one or more professional areas delivering some HR functions, such as administrative, information and processing activities. Whatever the nature or size of the organisation, the Associate Member gives vital support in one or more of the key component areas of human resources. So they may work within the central HR team, or in learning and development, or another of the professional areas within the HR remit. They may be someone setting out on an HR career, aiming for progression to Chartered Membership as they develop their skills, knowledge and experience. Or they could be someone who wishes to continue supporting fellow professionals without moving to Chartered Membership, but would like formal recognition for their existing role and contribution. Whichever it is, the Associate Member completes tasks and addresses problems that are well-defined but still have a degree of complexity. Operating within clearly defined limits they exercise some autonomy and judgement, taking and implementing appropriate decisions. The basis for their discretion is their knowledge and understanding of the organisation, and the established range of HR policies, processes, procedures and practices that they help deliver. Associate Membership signifies that this is someone who has been assessed against clear professional criteria – someone who demonstrates that they have the skill, knowledge and approach to make a significant supporting contribution, and deliver excellent results. It also confirms that they have signed up to the CIPD CPD Policy and Code of Professional Conduct, and work to its standards and criteria. Meeting the criteria To achieve Associate Membership the individual has to show that they have delivered against the criteria in a work environment. There are three elements in the criteria. 1. Activities – what the Associate Member does 2. Knowledge – what the Associate Member understands in order to carry out he activities 3. Behaviours – how the Associate Member carries out the activities. Activities: what the Associate Member does The Associate Member uses their specialist HR skills and knowledge to support HR leaders and managers, delivering information and services as and when required: consistently, on time and to standard. To do this the Associate Member: Maintains and produces management information collects and collates financial and non-financial data and statistics on the HR activities and processes within their work role converts raw data into meaningful HR and management information, and passes it on to managers and HR specialists, to inform plans, decisions, budgets produces clear and meaningful reports and updates, regularly and/or on request maintains HR record systems and individual records, with full, accurate and appropriate information and in line with data protection laws and regulations. Supports HR colleagues and line managers provides line managers/others with accurate and timely information/advice on HR policies, procedures and practices, in line with the organisation values and relevant regulations helps ensure that all HR processes provide equal opportunity, promote diversity, are based on merit and are applied equitably, fairly, reasonably and without bias manages the administration of continuing or one-off HR programmes, workshops, or meetings, and helps in their delivery. Supports improvement in processes and policieslooks for continuous improvement opportunities in HR processes, and feeds messages, ideas and observations to senior HR colleagues or managers supports change initiatives and programme implementation, maintaining service during the process and at the same time testing new approaches helps staff and managers outside HR to understand the need for and benefit of change, their role in the process, the next steps and the expected results. Maintains th eir Continuing Professional Development (CPD) enhances their professional skills, knowledge and behaviours through reflective and planned CPD. Knowledge: what the Associate Member understands To carry out the Activities the Associate Member has to know about and understand three contexts: 1. the organisation they work in or with 2. their specific work role (such as: generalist or specialist role) 3. the wider HR context. 1 The organisation and its context, including: the organisation’s structure, culture and operations its goals, targets and financial structure its HR policies, procedures, programmes, processes and practices its range of products and services and who its customers are how its teams work together to optimise performance. 2 The specific work role and the HR area(s) that are the focus for it, including: the relevant and appropriate legal and regulatory framework, and the external bodies and agencies that legislate and/or give advice and support how to contribute to the effective implementation of the organisation’s HR processes, procedures, practices, tools, techniques and approaches. 3 The wider HR context, including: how the different HR activities form an integrated whole, and the way that an action in their own professional area can affect other areas and impact on colleagues how to:plan and prioritise activities and their own work effectively, efficiently, on time and within budget -communicate effectively with employees at all levels -deliver service excellence, handle and resolve complaints and deal with difficult customers -use IT effectively and efficiently (specifically HR information systems). Behaviours: how the Associate Member carries out activities In delivering the Activities the Associate Member has to demonstrate how they meet the Behaviour criteria, organised in three clusters: Insights and influence, Operational excellence, Stewardship. Insights and influences 1. Curious keeps up to date with developments, ideas and trends in HR, the organisation and its sector. Uses information to inform personal CPD plans accepts and acts on feedback on their performance, taking action to broaden their experience, knowledge and skills uses information to inform personal CPD plans. 2. Decisive thinker uses knowledge and judgement to identify options and make day to day decisions makes sure information is accurate, consistent and relevant, before using it to carry out a task or make a decision. 3. Skilled influencerworks with other people to help gain commitment and support for changes or policies, using the appropriate communication channel or method puts forward logical and evidenced suggestions. Operational excellence 4. Driven to deliver identifies the steps needed to achieve agreed objectives, focusing on priorities keeps track of progress, to deliver on time and meet or exceed expectations. 5. Collaborative builds and maintains a network of useful contacts and relationships to support colleagues shows sensitivity and respect for other people’s feelings, cultures and beliefs. 6. Personally credible provides sound, realistic and impartial adviceconsistently delivers their promises and commitments and accepts responsibility for their actions, even when facing opposition. Stewardship 7. Courage to challenge shows courage to speak up, asks questions or for information, help or advice from other people when faced with unfamiliar issues or circumstances. 8. Role model demonstrates sound personal values and ethics, and operates within the organisation’s values, processes and expected behaviour supports colleagues in times of high workload or pressure deals with confidential and sensitive HR matters and data in line with professional good practice and the legal requirements.

Holistic Care Nurse Essay

The name and other identifying information about the patient included within this piece of work have been changed to protect confidentiality, as required by The Code of Professional Conduct (Nursing and Midwifery Council, 2008). For this reason, the patient included in this case study will be given the pseudonym of Sam Jones.The purpose of this assignment is to identify one client problem and provide an evidence-based plan of care for the individual. The purpose of care planning is to show a logical and systematic flow of ideas through from the initial assessment to the final evaluation (Mooney and O’Brien, 2006).The nursing model that will be incorporated in this care plan will be the Roper, Logan and Tierney’s model (2000). This model was chosen because is it extremely prevalent in the United Kingdom and is the most widely used model familiar to nurses. The model of nursing specifies 12 activities of daily living which are related to basic human needs and incorporates five dimensions of holistic care, physiological, psychological, sociocultural, politicoeconomical and environmental (Roper, Logan and Tierney’s model, 2000).Care plans are based on evidence-based practice, allowing the nurse to determine the best possible care and rationale for the chosen nursing interventions (Roper, Logan and Tierney, 2000). They take into account the psychological, biological and sociological needs of the person and therefore provide a holistic approach to care (Roper, Logan and Tierney, 2000). The main activity of living that will be affected within this care plan will be maintaining a safe environment as Mr. Jones may have a potential problem of death, due to hypovolemic and/or metabolic shock caused by ketoacidosis.Diabetic ketoacidosis (DKA) usually occurs in people with type 1 diabetes mellitus, but diabetic ketoacidosis can develop in any person with diabetes (Diabetes UK, 2013). DKA results from dehydration during a state of relative insulin defici ency, associated with high blood levels of sugar level and ketones (Diabetes UK, 2013). This happens because there is not enough insulin to allow glucose to enter the cells where it can be used as energy so the body begins to use stores of fat as an alternative source of energy, and this in turn produces an acidic by-product known as ketones (Diabetes UK, 2013). It is evident that DKA is associated with significant disturbances of the body's chemistry, which should resolve with appropriate  therapy (Diabetes UK, 2013).Severe metabolic acidosis can lead to shock or death (Dugdale, 2011). The specific problem was chosen because there are measures that can significantly reduce the risk of metabolic and hypovolemic shock which can be caused by severe metabolic acidosis (Dugdale, 2011). Within the care plan relevant care interventions will be identified to prevent the possible development of shock for Mr. Jones. In practice the interventions would happen contemporaneously.The intervent ions involve identifying the potential risk factors for the development of shock by using specific assessments. This will be done by following an assessment which includes planning, assessing, implementing and evaluating the care that will be provided to Mr Jones and to evaluate its effectiveness (Mooney & O’Brien, 2006).Once the diagnosis was made, specific, achievable, measurable, realistic and time limited goals of care for Mr. Jones were made. The NHS foundation trust specific guidelines for adult diabetic ketoacidosis suggest a series of immediate actions and assessments for suspected DKA which will allow for appropriate interventions to be made and will provide a baseline which will provide a measure of the effectiveness of the treatment (The Joint British Diabetes Societies Inpatient Care Group, [JBDS], 2012).Mr Jones will need fluid and electrolyte management to clear ketones and correct electrolyte imbalance (Nazario, 2011). He will also require pharmacological invol vement which will include administrating medication that is needed to reverse the acidosis, raised blood glucose and pH levels (Nazario, 2011).Psychological intervention is also necessary to reduce his anxiety and therefore reduce potential shock (Nazario, 2011). The goal of treatment for Mr Jones is to lower his high blood sugar level with insulin an hour after the insulin infusion is administrated with the expected outcome of maintaining a blood glucose level in the range of 8.3mmol/l – 10.0mmol/l within 72 hours (JBDS, 2012). Due to this it is vital that Mr Jones’s blood sugar is monitored and regulated frequently (JBDS, 2012).Another goal is to replace his lost body fluids; intravenous fluids will be given to treat dehydration and dehydration status will be assessed every hour by monitoring intake and output, skin turgor and vital signs (JBDS, 2012). Mr. Jones will be able to understand the care that is being given and why it is being given within 30 minutes of dia gnosis and he will also be able to express his fears and discuss his needs with nursing staff, which  combined with improvements in his blood sugar levels will reduce his anxiety.Intervention one: Fluid and Electrolyte ManagementAccording to The Joint British Diabetes Society (2012) the usual cause of shock in DKA is severe fluid depletion secondary to osmotic diuresis leading to intravascular volume depletion. Diabetes Daily (2013) justify this by stating that dehydration can become severe enough to cause shock. So once a diagnosis of DKA has been established, fluid replacement should be commenced immediately (Park, 2006).According to Oaks and Cole (2007) the development of total body dehydration and sodium depletion is the result of increased urinary output and electrolyte losses. They state that insulin deficiency can also contribute to renal losses of water and electrolytes (Oaks and Cole, 2007). The Joint British Diabetes Society (2012) suggests that the most important initia l therapeutic intervention when treating a patient with DKA is fluid replacement followed by insulin initiation. They also state an adult weighing 70kg or above presenting with DKA may be up to 7 litres in fluid deficit with associated electrolyte disturbances (JBDS, 2012).Rhoda, Porter and Quintini (2011) propose that a fluid and electrolyte management plan developed by a multidisciplinary team is advantageous in promoting continuity of care and producing safe outcomes. The development of a plan for managing fluid and electrolyte abnormalities should start with correcting the underlying condition (Rhoda, Porter and Quintini, 2011).In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia (state of normal body fluid volume) (Rhoda, Porter and Quintini, 2011). The Joint British Diabetes Society (2012) propose the main aims for the first few litres of fluid replacement are to clear ketones and correct electrolyte imbalance.The Joint British Diabetes Society (2012) has issued guidelines on the management of adults with DKA to each NHS foundation trust. The guidelines state that intravenous fluids should be commenced via an intravenous cannula (JBDS, 2012). It is recommended that 9% Sodium chloride 1000mls should be infused initially over one hour (JBDS, 2012).Park (2006) clarifies this by stating that slower rates have been associated with a more rapid correction of plasma bicarbonate and it is recommended that 1000mls is to be infused in the first hour. Rhoda, Porter and Quintini (2011) propose that after fluid status is corrected,  electrolyte imbalances are simplified.To correct dehydration and achieve the goal of rehydrating Mr Jones, several assessments will need to be completed. Rhoda, Porter and Quintini (2011) suggest that after a plan is developed, frequent monitoring is vital to regain homeostasis. Mr Jones’s urine output, heart rate, blood pressure, respiratory rate and pulse oximetry will be monito red hourly to ensure the treatment being given is working effectively (JBDS, 2012).Also, to assess the degree of dehydration a variety of specific observations will need to be carried out including observing neck veins, skin turgor, mucous membranes, tachycardia, hypotension, capillary refill and urine output (JBDS, 2012). A strict fluid balance chart will need to be in place to monitor input and output (Mooney, 2007).To continue with gradual rehydration and restoration of depleted electrolytes after the first 1000ml bag of 0.9% sodium chloride has been administered to Mr Jones over one hour a second 1000ml bag of 0.9% sodium chloride will be commenced over two hours and a third bag will then follow over another two hours (JBDS, 2012) . Following these two hourly bags of fluid another two bags of sodium chloride will follow at a rate of four hours and then another two bags will be commenced over six hours consecutively to ensure complete rehydration (JBDS, 2012).Pharmacology Interve ntionThe medication that was needed to resolve Mr. Jones’s acidosis and to prevent metabolic shock will be discussed in this intervention. A fixed rate intravenous insulin infusion is recommended by The Joint British Diabetes Society (2012) and stated on the NHS foundation trust DKA guidelines to reverse DKA.An intravenous insulin infusion via a pump should contain 50 units of actrapid insulin in 50mls 0.9% sodium chloride at a continuous fixed rate of 0.1 units/kg/hour (JBDS, 2012). If you are unable to weigh the patient an estimated weight will need to be made to calculate the units per kg per hour (JBDS, 2012).Whilst the infusion is running ketones and capillary blood glucose will be monitored hourly to screen for improvement (JBDS, 2012). Preedy (2010) and guidelines to DKA both state that if the patient normally takes long acting insulin (e.g. Lantus, Levemir) this should be continued at their usual dose and time. According to The Joint British Diabetes Society (2012) it is no longer advised to administer a  bolus dose of insulin at the time of diagnosis of DKA to allow rapid correction of blood sugar. Intravenous fluid resuscitation alone will reduce plasma glucose levels by two methods: it will dilute the blood glucose and also the levels of counter-regulatory hormones (JBDS, 2012).If the blood glucose falls too slowly, the insulin rate should be doubled every hour until the target decrease is met (JBDS, 2012). If the blood glucose falls too quickly, the insulin rate can be halved to 0.05unit/kg/hour, but for a short time only, as a rate of 0.1 units/kg/hour is needed to switch off ketone production (JBDS, 2012).If hypoglycaemia occurs prior to complete resolution of DKA, the insulin infusion should not be stopped, but extra glucose should be added to the IV fluids instead (JBDS, 2012). Diabetes Daily (2013) explain that if necessary, potassium should be administered to correct for hypokalemia (low blood potassium concentration), and sodium bic arbonate to correct for metabolic acidosis, if the pH is less than 7.0.For Mr. Jones neither of these was needed to correct his acidosis. JBDS (2012) can justify this as they clarify that intravenous bicarbonate is very rarely necessary. Similarly, Diabetes Care (2004) proposes the use of bicarbonate in DKA remains controversial. At a pH >7.0, insulin activity blocks lipolysis and resolves ketoacidosis without any added bicarbonate. Potassium is often high on admission but falls precipitously upon treatment with insulin (JBDS, 2012).Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells (JBDS, 2012). A large part of the shifted extracellular potassium would have been lost in Mr. Jones’s urine because of osmotic diuresis (Dugdale, 2012). Hypokalemia increases the risk of dangerous irregularities in the heart rate (Dugdale, 2012).Therefore, continuous observation of the heart r ate is recommended as well as repeated measurement of Mr. Jones’s potassium levels and addition of potassium to the intravenous fluids once levels fall below 5.3 mmol/l (JBDS, 2012). By 24 hours Mr. Jones had improved and was able to eat and drink. The guidelines state that by 24 hours the ketonaemia and acidosis should have resolved but you should continue intravenous fluids if the patient is not yet drinking as per clinical judgement (JBDS, 2012).The guidelines also suggest if blood glucose becomes lower than 14 mmol/L then 10% glucose should be prescribed to run alongside the sodium chloride (JBDS, 2012). Also, if Mr Jones’s  potassium had of dropped below 3.5mmol/L in the first 24 hours of treatment then additional potassium would have needed to be given (JBDS, 2012).Psychological InterventionA third intervention would be communication needs to reduce patient anxiety and keep the patient feeling secure. Communication plays an important part in the holistic care p lan and biopsychosocial approach to care. Anxiety can be a barrier to communication; therefore, it is important to communicate with Mr. Jones clearly and supportively in order to make him feel free to discuss his fears and to allow him to participate in the decisions made in his care. According to Sarafino (2008) anxiety appears to be caused by an interaction of biopsychosocial factors, including vulnerability, which interact with situations, stress, or trauma to produce added anxieties for the patient.The nurse should take a step by step approach to build a plan of care and voice the plan of care to Mr. Jones so he does not become overwhelmed by the extensiveness of the treatment (Sarafino, 2008). Communication is identified as one of the essential skills that health care professionals must acquire (NMC, 2010). The Nursing and Midwifery Council (2010) stipulate that, within the domain for communication and interpersonal skills, all nurses must do the following: communicate safely a nd effectively, build therapeutic relationships and take individual differences, capabilities, and needs into account, be able to engage in, maintain, and disengage from therapeutic relationships, use a range of communication skills and technologies, use verbal, non-verbal, and written communication, address communication in diversity, promote well-being and personal safety, and identify ways to communicate.Communicating with Mr. Jones relatives is also important so that they develop an understanding of his condition and the care he is receiving (Webb, 2011) According to Webb (2011) health professionals who can communicate at an emotional level are seen as warm, caring, and empathetic, and engender trust in their patients, which encourages disclosure of worries and concerns that patients might otherwise not reveal. Additionally, informative and useful communication between the practitioner and the patient is shown to encourage patients to take more interest in their condition, ask q uestions, and develop greater understanding and self-care (Webb, 2011).Webb (2011) explains that this is  particularly so when the patient is given time and encouragement to ask questions and be involved in their treatment decisions. By using the Roper, Logan and Tierney’s nursing model (2000) a holistic approach to care was able to be implemented for Mr. Jones by taking into account his biological, psychological and social needs. By establishing a holistic care plan three interventions were identified that were equally vital in treating Mr. Jones’s DKA to prevent hypovolemic and metabolic shock caused by his acidosis.The first intervention was the management of fluid and electrolytes put in place to achieve the goal of rehydrating Mr. Jones in aim to correct his electrolyte imbalance and clear ketones to prevent hypovolemic and metabolic shock caused by his DKA. The second intervention included pharmacological input which included the administration of relevant medi cation to achieve the goal of reversing Mr. Jones’s raised blood glucose and acidosis. Lastly the third intervention within the holistic care plan addressed Mr. Jones psychological needs by resolving his anxiety by utilising effective communication and interpersonal skills.It can be concluded that the care plan and treatment for Mr. Jones was successful therefore he did not require escalation to the high dependency unit and additional treatment was not necessary. Therefore it is evident from the success of Mr Jones care; care planning provides a structured and holistic method which in turn addresses all elements of an individual’s health and well being.AppendixThe individual chosen for this care plan is Mr. Sam Jones (a pseudonym, as explained in the confidentiality statement). This gentleman was chosen for the care plan as caring for diabetic individuals is becoming a more common activity within health care today. Mr. Jones is a 58-year-old builder who was admitted af ter being found collapsed at his home by his brother.He is 5ft 9† tall and weighs 88 kilogram’s. Mr. Jones lives alone in a centrally heated two bedroom semi detached house; he sleeps on the upper floor and is very independent and does not require a package of care. He has a daughter aged 22 who has two small children and also has a brother aged 64 who lives nearby with his wife.Mr. Jones has been diagnosed with type 1 diabetes since the age of 18 and has struggled with the management of his condition  resulting in numerous hospital admissions. Mr Jones stated he did not smoke but admitted to having an increased intake of alcohol. On arrival blood monitoring was performed which revealed un-recordable blood sugar levels which gave the clerking impression of diabetic ketoacidosis.The health care team then had the problem of potential death due to hypovolemic and metabolic shock caused by ketoacidosis. On admission to the medical assessment unit (MAU) numerous assessment s needed to be completed to discover the extensiveness of the condition and to provide baseline levels.Firstly, rapid ABC was performed with measurement of pulse, blood pressure, Glasgow coma scale, respiratory rate and pulse oximetry. Urinalysis was performed which indicated the presence of ketones, and glucose and samples were sent for microscopy, culture and sensitivity. The patients’ full blood count was taken as part of the ‘septic screen'.The patients’ capillary blood glucose was taken and venous blood samples were be sent to the lab for U&Es which is essential in order to assess the baseline potassium as well as giving a biochemical indication of dehydration and renal function. Laboratory glucose is also an essential baseline investigation to identify glucose and evaluate blood sugar concentrations (Association for Clinical Chemistry, 2011).A baseline ECG is a mandatory investigation for a patient with DKA (Turner 2012). Blood gas measurements were used to evaluate Mr. Jones’s oxygenation and acid/base status and from the blood gas a pH result was obtained as well as a bicarbonate levels and PC02 (the amount of carbon dioxide released into the blood) levels (ACC, 2011).The results of the numerous tests confirmed the diagnosis of metabolic acidosis. Metabolic acidosis is characterised by a lower pH and decreased bicarbonate, the blood is too acidic on a metabolic/kidney level. A pH less than 7.4, low bicarbonate and low PC02 will indicate metabolic shock and DKA (ACC, 2011). The assessments that were undertaken on Mr Jones revealed that he fitted the criteria for diagnosis of diabetic ketoacidosis.According to The Joint British Diabetes Society (2012) to diagnose DKA the three of the following must be present: blood glucose over 11mmol/l or known diabetic, blood ketones above 3mmol/l or urine ketone ++ or more and venous pH less than 7.3 and/or bicarbonate below 15mmol/l. Once the diagnosis was made, specific, achievable, measu rable, realistic and time limited goals of care for Mr. Jones were made.