A Universal Message in Mountains Beyond Mountains Essay

A Universal Message in Mountains Beyond Mountains The suffering and misery of the poor and destitute has long been reported on and documented by writers all over the world. The circumstances and stories of the less fortunate are accounted by authors who sometimes distance themselves from the people they write about. However, Mountains Beyond Mountains by Tracy Kidder focuses on the work of Dr. Paul Farmer, a man who works tirelessly to comfort the sick and dying in the poorest countries in the world. Instead of being a simple biography about a wonderful man, Kidder weaves his own message of human rights into the book. Kidder successfully conveys his message that universal healthcare is a right a not a privilege through the words and†¦show more content†¦The suffering of a poor man in America is not the same as a poor man in Haiti. A man in America has more access to hospitals, shelters, and basic needs than a man in Haiti. Kidder’s main message lies in this principl e. While progress has been made in medical technology in powerful countries, moral progress has not developed at the same rate. A man who would agree with Kidder’s message of the universal right of health care is Mahatmas Gandhi. In his speech Economic and Moral Progress Gandhi says that many people mistake economic progress for moral progress. He points out those countries have become more industrial as well as technologically advanced but this upgrade has been at the expense of their obligations to their morality. He cites an example he is very familiar with- the cruel oppression of the British Empire over India. The people were rationed to one meal a day, â€Å"No one has ever suggested that grinding pauperism can lead to anything else than moral degradation. Every human being has a right to live and therefore to find the wherewithal to feed himself and where necessary to clothe himself† (334). Gandhi asserts his belief that there are a basic set of human rights th at all people are born with no matter what country they live in, what their status, or how much money they earn. In part II of the book Farmer explains some of the circumstances that have been laid upon the HaitianShow MoreRelatedTracy Kidder’s Mountains Beyond Mountains Essay1942 Words   |  8 PagesTracy Kidder’s Mountains Beyond Mountains â€Å"The only real nation is humanity† (Farmer 123). This quote represents a huge message that is received in, Tracy Kidder’s, Mountains Beyond Mountains. This book argues that universal healthcare is a right and not a privilege. Kidder’s book also shows the audience that every individual, no matter what the circumstances, is entitled to receive quality health care. In the book Kidder represents, Paul Farmer, a man who spends his entire life determined toRead MoreSinister Games on a Dark Mountain1665 Words   |  7 Pagesagainst venturing into the woods after sunset; they pleaded, saying that people had gone into the forest and had never been seen again. But he had a deadline to meet. The traveler was carrying a letter for the magistrate of the county beyond the mountains, a message warning of an impending attack from the south. The traveler had to get to the county before dawn or all would be lost, so he hurried deeper into the unfriendly wilderness. He paus ed, leaning against an ancient oak to catch his breath.Read MoreThe Gospel According to Mark Essay983 Words   |  4 Pagesof the Son of God, Jesus often refers to himself as the Son of Man. The first example of the title, the Son of Man, comes when Jesus is speaking to the paralytic (2:10). Jesus also refers to himself as the Son of Man when descending the mountain with Peter, James, and John after his transfiguration (9:9). Jesus continues to refer to himself as the Son of Man, during the last supper (14:21) and while in the garden of Gethsemane (14:41). Jesus referral to himself as the Son of Man isRead MoreThe Beginning Of Creative Nonfiction1517 Words   |  7 Pagesvery first writing system, and their earliest accounts were of trade and commerce; in other words, writing began as nonfiction. Sumerian’s nonfiction was, unfortunately, the â€Å"worst kind of nonfiction: informational, literal, nothing about mattering beyond the place it held for facts† (Dâ€⠄¢Agata 2). Despite this overly factual writing, there arose one individual who â€Å"started literature,† as some scholars say. Ziusudra was the last king of Sumer. In a time of great distress, he wrote a list, called TheRead MoreThe Novel The Kingdom Of Arendelle 953 Words   |  4 Pagesback summer (Frozen). Frozen is Disney s current highest-grossing animated film at earning over a billion dollars (Guinness World Records). And that is no wonder. Certainly, Frozen defies many conventions Disney films previously fostered. It goes beyond the typical quest of finding true love in the romantic sense. Instead, we see two estranged sisters attempting to overcome their personal fears so they could rediscover the love they always had for each other. The story is about, more than anythingRead MoreThe End Of Solitude By William Deresiewicz1002 Words   |  5 Pagesa pizza or movie tickets. Deresiewicz states in his article â€Å"But as the Internet s dimensionality has grown, it has quickly become too much of a good thing. Ten years ago we were writing e-mail messages on desktop computers and transmitting them over dial-up connections. Now we are sending text messages on our cellphones, posting pictures on our Facebook pages, and following complete strangers on Twitter. A constant stream of medi ated contact, virtual, notional, or simulated, keeps us wired in toRead More Millennial Themes in The Prelude and Mont Blanc Essay1534 Words   |  7 Pagesstill in its earlier, more optimistic phases. As he had also done in Tintern Abbey, Wordsworth uses his memories of the travels of his younger days to reflect upon the changes in his life since those days, as well as to express his belief in The universal reason of mankind / The truth of young and old (VI. 476-477) that would always endure even through the most violent upheavals in society. Many times throughout The Prelude, and especially in his musings on the imagination and the One Mind inRead More Essay on Figurative Language in A Work of Artifice967 Words   |  4 PagesPiercys poem. The writer had focused strictly on the bonsai tree in lines previous to line 17. At line 17, she encourages the reader to relate the bonsai tree to living creatures. Opening up the topic of the poem beyond the concept of the bonsai tree is a method used to make universal connections to the ideas presented by the symbolism of the tree. Following the shift in voice, the writer chooses her words carefully to present her readers with the main theme: the comparison of the growth of a bonsaiRead MoreHow Do We Know Something?2341 Words   |  10 Pagesdetermine individuals. â€Å"This massive mountain (Mt. Blanca) stands at the southern end of the Sangre de Cristo range. Is it them really a thing, an individual, a primary reality? If the entire range is the primary reality, then Mt. Blanca is not a real thing. What is worse, if we go still further, the Sangre de Cristo range may not be a thing, but only a part of the entire Rocky Mountain chain, perhaps including the Andes as well. Which then is the individual: rock, mountain, or range? The question is embarrassingRead MoreEssay The Architecture of Moshe Safde1613 Words   |  7 Pagesgives the names, places of birth, and ages at death of each of the children that died. The voice does not repeat for six months. After going through this room, a hallway takes you back out into the sunlight out the side of the hill overlooking the mountains of Judea. (Safdie Architects) Eventually the museum was expanded and reworked and Safdie was hired for part of this as well. (Arc Space) Marina Bay Sands is a 845,000 square meter area and a $5.7 billion build cost project that was constructed

Genogram Family and Grandmother Essay - 1357 Words

Family Genogram Project Liberty University Family Genogram Project The purpose of a student construing a genogram is to help a student gain an understanding of his/her family background. By gaining knowledge of one family it can help the student assist other understand how to help their clients. However, genograms backbone is a graphic depiction of how different family member are biologically, legally, and emotionally related to one another from one generation to the next (McGoldrick, Gerson amp;Petry, 2007, p.21). A genogram display â€Å"family information graphically in a way that provides a quick gestalt of complex family patterns; as such they are a rich source of hypotheses about how clinical problem evolve in the context†¦show more content†¦I have a close relationship with my family. My example of a good relationship is my mother and grandmother interaction with one another. They are so awesome to be around, they act like they are still in their youths. For example, when we go to my grandmother home for holidays my mother has the same job of preparing the food for my grandmother. However, that has been her job since she was a young girl. My mother is my favorite person in this entire world. She raised me and taught me everything I know about how to be a woman. I love her more than anything on this earth. I dont think words can express how much I love and appreciate her for being there to guild me though my good and bad times. The following paper outline the assessment and analysis of the three generation of Knight and Spears’ families, its relationship, health pattern, habits, tradition and structure. â€Å"Assessing the family will help me understand my family so I can be able to know the key developments in relationship, health, and so on over the life cycle of the family† (McGoldrick, Gerson amp;Petry,2007.p 3). It will help provide myself with a clear understand of my family. The interview was conducted by my maternal grandmother first generation of ten and my mother in law a second generation of one. When I take a look at my family genogram it is really amazing how much was known on my mother’s side of the family and how little is known about my father’sShow MoreRelatedCase Study : Family Systems Theory943 Words   |  4 PagesA family rarely enters therapy with the clear-cut idea of where exactly it’s problem lie, and the therapist’s job during the first interview is to organize the facts and the characteristics of the family and analyze the emotional process in a way that locates the trouble spots in the relationship system. The choice of a particular method of evaluation depends on the ideology of the therapist, as well as the state of the family that enters therapy. In family systems theory, the family isRead MoreFamily Dynamics Can Be Composed By Emotional And Health Patterns962 Words   |  4 PagesFamily dynamics can be comprised by emotional, physical and health patterns. A family can have negative and positive emotional, physical and health functionality. The structured links’ navigate the interactions and commonalities between the family members. The connections are based upon a three generational genogram chart. The genogram begins with the grandparents on the father’s side then connects to the mother’s side of the family. The genogram depicts relational patterns structured with emotionalRead MoreThe Life Of Ileyna Gil1108 Words   |  5 Pagesof Ileyna Gil Genograms are like family trees with more details. Within a Genogram you can clearly see patterns and connections amongst numerous family members. Before I made my genogram, I had to do an interview with my client, Ileyna Gil. In this interview we discussed her family line, cultural background and religious beliefs. Religion was an important piece of her family’s life. After conducting the interview, I structured her genogram utilizing three generations of Ileyna’s family. After reviewingRead MoreThe Importance Of A Counseling Session For The Clinician And The Client1181 Words   |  5 PagesGenograms can be a very important to a counseling session for the clinician and the client. Genograms is a used by many health care disciplines to help understand the family dynamics and certain health care information of the client or patient. According Butler (2008) genograms were first developed by a man named Murray Bowen and his students. Butler (2008) suggest that genograms where first acknowledged as â€Å"Bowen theory† (pg.169). However, it would soon be a normal practice for family counselorsRead MoreMental Illness And Its Effects901 Words   |  4 Pages I have chosen to include seven immediate family members in my family genogram. These family members include my grandfather, John Brown, who was a deacon at a Baptist church before his passing. My grandmother, Susan Brown, who is currently caring for my sister and her child. Also included is my mother, Yvonne and her two younger sisters Pamela and Adrienne. Both my mother and her sisters are currently unemployed. In this genogram, I have also included my brother Aaron, and my sister Kristin. MyRead MoreMy Best Friend B. Jr.852 Words   |  4 Pages Genogram When selecting a family for this project, I looked for a family that had a large complexity in within each generation. I decided to interview my best friend B. Gibson Jr. A little history about Mr. Gibson. Mr. Gibson is a junior to his father. He is 43 years of age. Is in his second marriage for 15 years with to P. S. Gibson. They have 4 children, a set of twin’s boys that are 15 and two girls ages 13 and 12. B. G. Jr., is a retired military veteran of 15 years with a degreeRead MoreWhat A Genogram Is More Than A Family Tree1293 Words   |  6 PagesIntroduction A genogram is more than a family tree. It is a visual interpretation of a family and their relationships. A genogram says a lot about a family. It uses symbols to describe the relationships between family members. One can use a genogram to tell the dynamics of a family. Sometimes, there are patterns that are passed down generation to generation. The purpose of this paper is to go into more detail about what a genogram is and what it means. Also, I have provided a genogram of my family on theRead MoreThe Issue Of Concern : A Interview With My Client835 Words   |  4 Pagesaccording to Journal of Family Social Work, the average time for genogram interviews was 20 min. After performing the structural interview, I was able to create a genogram to visually show Mickey the divorce pattern in his family generations. Mickey mouse last three generations have all gotten a divorce, just as he did. This allowed myself and Mickey to know that it has become a pattern in his family and gave us a starting point for what issue to address. After displaying the genogram to him, he asked meRead MoreMy Experience With My Family1002 Words   |  5 PagesWhile working on my genogram I found it a bit difficult to put it all onto a page. I have information dating back to my great great, grandparents on both side of my parents. Although I do not have all the information pertaining to my great aunts and uncles etc. I do have most of the information from my great great, grandparents down to my parents. My great grandfather on my mom’s side died of old age at 96 years, while his first wife died of breast cancer sometime in the late 40’s. His second wifeRead MoreGenogram: A Graphic Representation559 Words   |  2 Pagesï » ¿A genogram is a graphic representation of a family tree that provides detailed information on relationships among individuals.  More than a traditional family tree, it provides data that can be used to analyze hereditary patterns and psychologi cal factors that characterize relationships (GenPro, 2012). One use for the genogram is therapeutic; genograms provide a visual for a therapist and his/her patient that can help quickly identify and understand various patterns in the patients family history

Explication de Texte of Main Street by Sinclair Lewis Free Essays

string(108) " that got to do all the trusting†, and in a dramatic aside, whispers to Carol â€Å"gentleman hen† \(59\)\." I. SUBJECT Carol Milford is a student of Blodgett College, and the protagonist of Main Street by Sinclair Lewis. Her ambition is to settle down in a prairie village and transform it into a place of beauty. We will write a custom essay sample on Explication de Texte of Main Street by Sinclair Lewis or any similar topic only for you Order Now She works as a librarian at St. Paul after her graduation. She marries the doctor Kennicott, whom she met at a friend’s house. Life in Gopher Prairie offers no challenges. Kennicott takes her on a long tour to California and other places. Carol returns to Gopher Prairie and tries to be enthusiastic about the town but feels tired of the hypocrisy and decides to leave. Kennicott feels distressed and she assures him that she would come back if she is able to find out what she needs. She works in Washington for two years. Kennicott visits her in Washington to woo her for the second time. Carol mellows and admits her desire to return to Gopher Prairie. Kennicott asks her to return only when she is prepared. She talks to the leader of the suffrage movement who tells her that she cannot achieve anything without total dedication. She convinces Carol that she can play at least a small role in changing life by persistently asking questions whenever she finds anything that hinders social change. Her life in Washington helps her to acquire a mature outlook towards life and is at last able to accept Gopher Prairie and its people as they are, but she does not give up her fight to make Gopher Prairie a better place. She gives birth to a daughter and feels optimistic that her daughter will carry on the fight that she had started and witness a united world. II. THEME The main theme of the story is rebellion and reformation. The rebellion is against materialism, lack of equality between the rich and the poor, the ugliness of the town, its narrow-mindedness and its prejudices. Carol wants to reform the town by teaching the people to appreciate poetry and to surround themselves with beauty and by teaching them to play. She tries to put up a play, read poetry to Kennicott and campaign for a new city hall, school and a better rest room and also by organizing parties and games. Though she cannot bring about any radical changes, her triumph lies in utting up a fight and keeping her faith. Main Street brings to light the discontent of the protagonist because of her inability to bring about a change in the attitudes of the people of Gopher Prairie. She appreciates beauty of simplicity. She believes that life should uphold the virtues of equality and freedom. She disapproves of exploitation. Therefore she opposes the industrialization which wipes out the b eauty of the land and the spirit of adventure of the pioneers of America. She also rebels against the exploitation of the farmers and the laborers. She incurs the wrath of the matrons of Gopher Prairie by paying six dollars a week to her maid and also by justifying the wages by pointing out that the job they did is very tedious. She insists that the rest room for the farmer’s wives should have better facilities, because it brought the farmer’s business to the merchants of the town. The reforms she proposes are very simple. She wants beautiful buildings. She wants to cultivate the taste of the people. She wants to teach the farmer’s wives the proper way to care for their babies and to make good stew. She suggests setting up an employment bureau so that they will not depend on charity. The women of Gopher Prairie snigger at Carol’s suggestions. They oppose the idea of empowering the poor women to be self-sufficient because that will deny them the chance to be charitable. When Carol suggests that they should mend the clothes before handing them out as charity, the women pounce once again on Carol and overrule the suggestion as unnecessary because it would encourage those women to be lazy. Carol feels frustrated by this mindlessness. Hence she leaves Gopher Prairie so that she can find out what she can achieve in life. In Washington, she gains the objectivity necessary for any reformer. She gains courage and learns how to direct her energy to effect changes, and returns to Gopher Prairie reconciled. The minor theme of the novel is that marriage is not to be taken lightly. Carol does not accept the institution of marriage blindly. Her expectations and demands as a wife are juxtaposed with the other wives in Gopher Prairie. Her rebellion seeps into her personal life as well and makes it so much the better for it. III. DICTION Sinclair Lewis has a vivid style. His description of nature provides the appropriate background for the mood of the characters. When Carol goes out for a walk with Erik they pass a grove of â€Å"scrub poplars†¦ looming now like a menacing wall† (392). When she is with Kennicott beside the lake she watches â€Å"long grass†¦ mossy bogs and red winged black birds† (57). When she is brooding she sees gray fields closing in on her. He uses verbs very effectively. Carol â€Å"perceives† when she observes something seriously. When she is upset with Kennicott for forgetting to give her money, she â€Å"commands† him to come upstairs because she does not wish to discuss the matter in the presence of company and Kennicott â€Å"clumps† after her. His use of satire is very effective and adds color to his narration. Carol watches a professional play, which to her is boringly ordinary in all aspects and finds the audience lapping it up. She comments sarcastically that â€Å"the only trouble with The Girl from Kankakee is that it is too subtle for Gopher Prairie† (225). The description of the idiosyncrasies of the occupants of Gopher Prairie is full of humor. When Raymie praises about the trust of Kennicott’s patients in the doctor comments wryly, â€Å"It’s me that got to do all the trusting†, and in a dramatic aside, whispers to Carol â€Å"gentleman hen† (59). You read "Explication de Texte of Main Street by Sinclair Lewis" in category "Papers" When Kennicott is excited about the motor trip he expects Carol â€Å"to be effusive about academic questions as ‘now I wonder if we could stop at Baraboo†¦ ’† (196). Kennicott’s faith in cars is a â€Å"high-church cult with electric sparks for candles, and Piston rings become the alter-vessels† and â€Å"liturgy† composed of â€Å"intoned and metrical road comments† (196). The plot moves through a combination of dialogue and narrative. With minor pauses in some seemingly meaningless conversation, the diction shows the inner workings in Carol’s mind and throughout the other characters of Gopher Prairie, such as Vida who was a devout Christian. The narrative half of the plot gives insight characterization. For instance, she says this to no one, but Vida had considered her moment with â€Å"Professor’ George Edwin Mott† somehow naughty, and thought that she was â€Å"superior†¦ to have kept her virginity† (251). The diction upholds the subject and theme through the usage of words such as â€Å"reformer†, â€Å"suffragist†, and other choice words involving civil rights. It relates to Carol’s constant want to change the town of Gopher Prairie, and the other reformations happening in Washington, D. C. and the opposition she faces in her town, and in her own home. In times of despair, she finds her surroundings closing in around her: â€Å"She saw the furniture as a circle of elderly judges condemning her to death by smothering† (31). IV. TONE The atmosphere of hostility is produced by the conflict between Carol’s desire to change the town and the town’s resistance to Carol’s ideas. She is bewildered and hurt by the rebukes and rebuttals. Carol develops the right attitudes necessary for a reformer in the last three chapters of the novel. This helps her to face life with more sympathy, tolerance and hope. V. SYMBOLISM Carol’s interests in trains, books, and nature all symbolize her desire to escape the narrow confines Gopher Prairie. In Chapter 19, she daydreams about taking a train to escape the town. In Chapter 22, she escapes the town mentally through reading a number of books. Beginning in Chapter 5, she finds natural beauty in the countryside that she does not find in town. Indeed, throughout the novel, Carol often takes walks and spends time in the countryside in order to escape Gopher Prairie. In Chapter 2 and Chapter 38, Kennicott shows his wife pictures of Gopher Prairie as he attempts to court her and convince her return to the town. In Chapter 2, Carol sees only â€Å"streaky† pictures of â€Å"trees, shrubbery, a porch indistinct in leafy shadows, [and] lakes† (18). The fact that she sees the pictures in Chapter 2 as â€Å"streaky† and â€Å"indistinct† symbolizes her detachment from the community. However, in Chapter 38, she sees her own house and familiar faces in the photographs, symbolizing her connection to the town. As Lewis indicates in his preface, Gopher Prairie represents a microcosm of America in the early twentieth century. Lewis creates many characters as exaggerations, or typical, rather than individuals, to suggest that the people and institutions found in Gopher Prairie can be found anywhere. By criticizing Gopher Prairie, Lewis therefore attacks American society as a whole. Carol and Vida seem to be foils in that Carol is a reformer, whereas Vida is the representation of a society reluctant to let go of their ways. Though in a passage Vida thinks that she is, â€Å"and always will be, a reformer, a liberal† (253), she puts lie to this statement at the beginning of the chapter: she displays as much open-mindedness as a nun when Lewis writes that â€Å"[s]he hated even the sound of the word ‘sex’†¦ and prayed to Jesus†¦addressing him as her eternal lover† (251). Carol, on the other hand, indeed does try to bring reform to the town. She tries to bring beauty and culture, but is met by the bulwark of Gopher Prairie. Yet still she pushes on, introducing a professional play, music and poetry. Despite all her attempts, she still fails. Though some battles cannot be won, she wants to give her fighting spirit to her daughter. VI. SPEAKER The speaker of Main Street is in third person, who is omniscient of the happenings and minds of the citizens of Gopher Prairie. VII. STRUCTURE The novel is divided into six parts, plot-wise. The first part introduces Carol, the heroine of the novel. The second part deals with her marriage and elaborates on her fears of life as the wife of Dr. Kennicott in the small prairie town. The third part describes her house warming party in which Carol makes a statement about her taste and attitude followed by the details of the trials and tribulations of Carol as a reformer of the smug town. The fourth part is the thirty-sixth chapter, which may be called the climax of the story because Carol walks out of her marriage and Gopher Prairie. The following two chapters form the fifth part which describes Carol’s work in Washington, her reconciliation to life in Gopher Prairie and it also reunites Carol and Kennicott. The physical construction of the novel consists of a yellow and black cover, with a small portrait of the author in the approximate middle. It is four hundred and fifty-one pages, divided into thirty-nine chapters, which are then sub-divided; both are numbered by Roman numerals. Preceding the story is a miniature biography of the author (viii) and a small preface that explains Gopher Prairie is a small pocket of America, but America nonetheless, whose citizens are set in their ways. VIII. IMAGERY This is an example of personification: â€Å"the land humming† (139). This describes the beauty of the land around Gopher Prairie and inspires Carol, since she wants to make the town just as beautiful through her reforms. This is an example of a simile: â€Å"Kennicott was as fixed in routine as an isolated old man† (291). With the use of â€Å"as†, Kennicott is compared an old man being set in his ways. An example of antithesis would be that when Kennicott, before his marriage to Carol, had put his arm around Vida â€Å"carelessly†. While she strained away, she longed to move nearer to him† (251). In this example of personification, â€Å"the deep-bosomed bed stiffened in disgust† (32) at having such an extravagant shirt laid on it. In the same paragraph, the said â€Å"chemise and lace was a hussy† (32) and seemed overly lavish in the simple house in which Carol lived. In this conceit, Lewis writes that â€Å"[a] villag e is†¦a force seeking to dominate the earth, drain the hills and seas of color† (267). He is saying that such a village drains the world of its natural beauty, to be replaced by man-made materialistic things, with a standard style. Anything else would seem out of place. Carol calls the people who live in the Northern Middlewest â€Å"pioneers, these sweaty wayfarers† (24). They have just begun to build a society in that area, and she thinks that such an area has much hope. When Dr. Kennicott takes Carol hunting, she wonders why he hasn’t fired when a â€Å"crash† sounded and â€Å"two birds turned somersaults in the air, plumped down† (55). Such is an example of onomatopoeia. How to cite Explication de Texte of Main Street by Sinclair Lewis, Papers

The Cushing’s syndrome with Type Diabetes & Rheumatoid Arthritis

Question: Discuss about the Cushings Syndrome with Type Diabetes Rheumatoid Arthritis. Answer: Incidence Causes of the Cushings Syndrome Statistics indicate that out of every 1 million people, 13 of them are affected by the Cushings syndrome. It is however more common among women as compared to men. The condition mostly presents when a person is between 25 to 40 years of age (Wilson et al, 2014). The Cushings syndrome is caused by elevated levels of the cortisol hormone in the body. This hormone is produced by the adrenal glands in order to carry out various roles in the body. The functions of cortisol for instance includes; regulating blood pressure, ensuring the normal functioning of the cardiovascular system and further, it helps the body to respond to stress (Ding et al, 2013). Cortisol therefore controls protein and fat metabolism into energy but one develops the Cushings syndrome when the hormone levels go high. Another cause of the Cushings syndrome includes the excessive use of corticosteroids. Oral corticosteroids taken by individuals as medication in high doses particularly over a long period of time causes this condition (Graversen et al, 2012). Corticosteroids include prednisone which is used to treat rheumatoid arthritis, asthma among other inflammatory conditions; has similar effects as those of the cortisol hormone. Since these doses are higher than the amount of cortisol produced within the body, the Cushing syndrome occurs due to the side effects of excessive cortisol. Risk Factors The risk factors for the development of the Cushings Syndrome include exogenous use of corticosteroids as in the treatment of rheumatoid arthritis for Maureen Smith in the case study. As described above, prednisone is one of the major corticosteroids contributing to the Cushings syndrome, as a medication for rheumatoid arthritis (Ding et al, 2013). Another risk factor includes the presence of pituitary adenoma where the pituitary gland secretes excessive ACTH that consequently stimulates the secretion of excess cortisol by the adrenal glands (Wilson et al, 2014). This is common in women and is referred to as endogenous Cushings syndrome. Thirdly, the presence of a tumor that secretes ectopic ACTH in any organ that does not normally secrete ACTH will contribute to its excessive presence in the body and thus more cortisol production to lead to the Cushings Syndrome. Such organs could be the lungs, the thymus gland, thyroid and even the pancreas (Graversen et al, 2012). Adrenal adenoma which is a tumor that affects the adrenal cortex but not cancerous also contributes to the Cushings syndrome. This is because adrenal adenoma contributes to the production of cortisol without the control by the ACTH. However, adrenocortical carcinomas such as benign and/or nodular adrenal gland enlargement also result to the Cushing syndrome. Impact on Patient and Family Among the impacts the Cushings Syndrome on an individual and their families include the high treatment and management costs of the condition especially when it is associated with other complication like rheumatoid arthritis and diabetes. A better amount of finances which could be put to other individual and family use is diverted to settling bills for healthcare (Torio, 2013). Another impact is that the victim might likely not be able to report to their workplaces just like Maurine Smith might not feel adequate to work at the pizza restaurant. The families members including their children take up the role of caregiving in order ensure their family member is happy (Graversen et al, 2012). Patients who suffer from the Cushings syndrome can suffer depression and even anxiety. The families will also have difficulty taking care of the emotionally affected relative. Common Signs and Symptoms for the Cushings Syndrome Sign/Symptom Pathophysiology 1. Development of a buffalo hump. It is one of the commonest sign and symptom especially among women with the Cushings syndrome. A buffalo hump occurs at the upper back and it is caused by an accumulation of fats at this particular part of the body (Ding et al, 2013). The fats accumulate to form a fat pad at the upper back. 2. Reduced general body immunity where individuals are very susceptible to infections. The Cushings syndrome results in a decrease in the production of lymphocytes by the immune system. The body also has a suppressed formation of antibodies to fight off harmful microorganisms and/or organisms (Wilson et al, 2014). As a result, the patients are prone to a variety of diseases especially after a longer stay with the condition. 3. Round moon face Round moon face is caused by the deposition of fats within the mid-section, shoulders and upper back (March et al, 2014). The moon face is particularly caused by the deposition of excessive fast over an individual patients face. 4. Obesity around the trunk Truncal obesity occurs among Cushings syndrome patients as a result of the development of fat pads around the trunk (Gadelha et al, 2014). When the condition presents occurs along with diabetes, obesity increases because there is reduced break down of fats to glucose, leaving them to accumulate within the subcutaneous tissue as fat pads. 5. High blood Pressure This is occurs as the general response to the increased amount of cortisol levels in the body. However, the main factor that contributes to the high blood pressure among the Cushings syndromes patient is fluid retention (Ding et al, 2013). The patients suffer from water and sodium retention which bring about this particular hypertension. The narrowing of the arteries due to low density lipoproteins and plaques both of which result from poor diet also increase the blood pressure as their lumen narrow up. Common Classes of Drugs for the Cushings Syndrome Their Physiological Effect Cortisol-secretion inhibiting drugs This is a class of drugs used in treating the Cushings Syndrome, which mainly inhibit the secretion of the cortisol hormone by the adrenal glands. In particular, this class of drugs inhibits steroidogenesis in the body and thus lower the levels of cortisol present in blood. These drugs include Metyrapone, mitotane, ketoconazole and aminoglutethimide (Wilson et al, 2014). Ketoconazole is currently the most popular drug in the treatment of the Cushings disease. Even so, the other cortisol inhibiting drugs can also be administered alone and/or as combinations. Another significant cortisol suppressing drug used in the treatment of the Cushings syndrome is Mifepristone. This particular drug is the most appropriate for the treatment of people with Cushing disease who also have type 2 diabetes (Gonzalez et al, 2016). From the case study, it is clear that Maureen Smith has type 2 diabetes that resulted from the use of corticosteroids as medication from rheumatoid arthritis and her Cushings s yndrome. Mifepristone is also approved for use by individual patients suffering from glucose intolerance. The drug hinders the effect of the cortisol hormone on the tissues of a patient. It however has several side effects just like the rest of the above discussed cortisol inhibiting medications. These include vomiting, fatigue, headaches, nausea, edema, muscle aches, and low potassium levels in blood and high blood pressure (Gadelha et al, 2014). More serious side effects may also present and these include hepatic toxicity and/or neurological side effects. Adrenocorticotropic Hormone (ACTH) Suppressing drugs This class of drugs is the alternative medication to the cortisol inhibiting drugs described above, for the treatment of the Cushings syndrome. They are however not popular choices as standard medications for the treatment of this particular condition. These drugs specifically suppress the effect of the Adrenocorticotropic hormone on the adrenal gland to secrete cortisol according to Laws et al (2013). They therefore target to inhibit the ACTH effect on the adrenal glands rather than targeting the cortisol hormone (Gadelha et al, 2014). These drugs include for instance, cyproheptadine, cabergolin, vasopressin antagonists, valproic acid, and PPAR-gamma agonists among others. The latest medications under this class include pasireotide which also decreases the production of the Adrenocorticotropic hormone by a pituitary tumor. Pasireotide is usually administered in two injections two times a day. In cases where pituitary gland surgery is rendered unsuccessful, Pasireotide is the most re commended drug under this particular class. Even so, it has several side effects among them being nausea, headaches, diarrhea, high blood sugar, fatigue in the muscles and joints, and pain in the abdomen. Nursing Strategies The nursing care strategies for the Cushings syndrome with both rheumatoid arthritis and type 2 diabetes for Maurine Smith in the first 24 hours after admission mainly include: lowering the corticosteroid medication dosage and/or reducing cortisol levels in blood, managing the high blood sugar, decreasing risk to injuries and infections, increasing self-care ability, improving the integrity of the skin, improving ones body image and mental functioning. According to Wilson et al (2014), emergency nursing strategies and medication for patients suffering from Cushing syndrome must be based on the cause of this particular condition. In this particular case, it is clear that the main cause of the condition for Maureen Smith is the use of the corticosteroids doses in the treatment of rheumatoid arthritis which she acquired at the age of 14 years. The effect of her corticosteroid use also contributed to the development of type 2 diabetes. The nursing strategies therefore for her current lif e threatening acute Cushings syndrome will include stabilizing the sugar levels but majorly reduce the use of corticosteroid use within the first 24 hours of post-admission (Gadelha et al, 2014). Therefore, the nurse should start decreasing the dose of prednisone being given to Maureen as treatment for rheumatoid arthritis. Even so, the signs and symptoms of both diabetes type 2 and the long term rheumatoid arthritis should remain under close monitoring. On the other hand the medical team including the nurse should use non-corticosteroid drugs for the management of the rheumatoid arthritis. There is need to slowly taper off the corticosteroid drugs in order to allow the patients body to return to its normal cortisol production mechanism (March et al, 2014). It is clear that the patient is severely hyperglycemic due to her diabetes type 2 condition. The first nursing strategy in this case should include rehydration by the use of intravenous saline. The patient can then be put on insu lin doses in measures of 0.3-0.4 units/kilogram of her body weight every day (Siu, 2015). The insulin doses can be given as bolus or basal. For instance, insulin glargine and insulin determir combination are the best options for both basal and/or bolus therapy. This intervention will help in lowering blood sugar levels from the current 14.0 mmol/L to the required levels, especially below 7.2 mmol/L (Emdin et al, 2015). Other urgent nursing strategies within the first 24 hours include administering adequate diet with lesser carbohydrates particularly for diabetic patients. Edema can be reduced by providing a diet with low levels of carbohydrate and Sodium. However, the diet should include higher amounts of vitamins and proteins in order to reduce some serious symptoms (Siu, 2015). The nurse should monitor the glucose and cortisol levels from the samples taken at intervals in order to administer the right medication. The patient should be encouraged to rest and relax within a quiet en vironment provided by the facility if she stabilizes within the first 24 hours of post admission. The nurse should ensure that they help the patient in changing position in order to prevent injury and promote the integrity of the skin. Acute conditions of both type 2 diabetes and the Cushings syndrome affect patients emotionally and therefore a need for nurses to improve the patients thought process (Emdin et al, 2015). The nurse should encourage both family and the patient to express their feelings and/or concerns openly. 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