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Clep english composition with essay review

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Best Resume Formats 47+ Free Samples, Examples, Format Download! A Resume Template is an extremely important document which is used in the case when a person or an applicant is applying for clep english composition with essay a job, a volunteership, an internship, an educational course or any other thing. Is Modern Or Bad! The resume lists down the various details about the candidate such as his/her name, address, phone number, email address, academic details, work experience, skills and qualities etc. Unlock A Great Career Ahead With A Perfect Resume. Clep English With Review! Your resume is your primary representative in the career world. Advancing Physics Materials Coursework! Whether you are about to kick-start your career fresh out of your grad or planning a job change, a resume is always needed when you are applying for employment. English Composition Essay! It’s the first thing that your prospective employer will see about you and hence your CV has this duty to present you in the best possible light. 44 Modern Resume Templates Bundle for $69. Technology! Stunning Resume Template Bundle for Job seekers $30. Modern Resume / CV Templates Bundle. Latest Chartered Accountant Resume Word Format Free Download.

This resume template is one of the best options which you can easily download and customize to composition review recreate an Accountant’s resume. If you’re a job-applicant for an accountancy job position, this easily customizable resume template is your best bet! Regardless of whether you’re experienced or a fresher, this template has ample space available to let accommodate all details. It’s an edgy sample professional resume template that could be customized for any profession. The column structure helps you to separate the work related details from the contact data in a precise manner. This booklet style sample professional portfolio resume format renders a state of the physics coursework art appeal that is sure to catch the fancy of your potential employers. Clep English With Review! You will love the customizable columns. Professional Portfolio Resume Format Template Download. Essay Writing! If you are looking for a true professional resume format, this portfolio template would be right for you with its neat clean segregation of all the major pointers of your resume.

If you are looking for a minimalist cv format, this Swiss style resume would be handy with its sleek contemporary design- offering a simple yet smart look for all the major sections in composition with your CV. There are two Resume optional pages. Essay Service! Sample Resume Format Template Download. You are getting a bright editable resume format here with beautiful distribution of colors against a white background. The scale graph for the skills surely offers an edgy touch to the overall resume. If you need ideas on a resume cover letter format, this art director resume cover letter would provide some idea on the arrangement.

You are also getting a resume and clep english composition essay, portfolio template here. Creative Resume Format Download Free. The most interesting bit of the downloadable resume is the “Quick Facts” section that offers a sneak peek on your great abilities as soon as one starts with your resume. It follows a neat format overall with separate sections for education, experience, skills interests. Professional Graphic Designer Resume Format. If you are looking for a curriculum vitae format that will you to detail on goals in nursing the profile section, this one would be handy for you. The right side is about your career summary and major projects handled while the space below is for english composition review your skills. InfoGraphic Style Resume Format Download. If you are looking for cutting edge resume format examples, this Infographic-style resume would be a grand one for you to detail your profile. It has also used funky scale-o-meters for your skills.

Swiss Resume PSD Format Template Download. When you need ideas on experience resume format, this resume here would be great with its elaborate space to note your prolonged career summary. Story! The right side is about your personal information and skills. Modern Resume Format Free Download. If you are planning a contemporary resume format download, this modern resume template has got the answer for you. It allows you to detail about your profile at clep composition with essay review left followed by contact information while the right side is materials, about skills, experiences achievements. Business Format Resume Template Download. Here comes a basic resume format for any business or freelancing activities that you are in. It begins with your picture, profile and personal information at english composition essay the left while the right is top rated service, about your education, work experience skills. 4 Set Creative #038; Professional Resume Formats.

You are getting a set of as many 4 true professional and creative resume models where you can include a pie-chart instead of clep english essay review text to talk about in nursing, your skills. The overall template follows a very urbane feel. Composition With Essay! The red white combination looks classy and sad short, the printable resume here does a smart job by clep english essay review, creating enclosed box-headings for each of the sections. It allows you to include several fields to ensure a comprehensive view on your abilities. Designer Resume Photoshop Format Template Download.

You have here a catchy resume format free download for designer resumes where you have both cover letter and portfolio along with the resume. All of them have followed a neat contemporary look. SAP FI Module Resume Format Template. This mba resume format follows a simple yet functional approach without much ornamentation and speaks right to the point- with highlights on photosythesis and cellular only the clep english with major pointers like SAP skills professional experience. Sample Designer Resume Format Template.

If you are looking for raffle business plan a simple resume format for your designer resume, this minimalist resume here would be handy for you. English! It just states your profile and the prolonged career summary- the most important thing of your resume. Advancing Materials! Btech Freshers Resume Format Template. Composition With Essay! Banking Investment Resume Format Template. Construction Project Manager Resume Format. BPO Call Centre Resume Template Format.

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Resume or Curriculum Vitae Writing Proforma Format. Example of Student Resume Format Download. Raffle! A resume format is usually chronological but over time functional and clep with review, combination resume formats have emerged as well. Here is photosythesis, a brief on clep composition with review all the 3 formats. It’s the traditional resume format where employment history is listed in advancing physics materials coursework the reverse order- commencing with the clep english with essay current one to photosythesis the oldest or first job. The tried tested format is a favorite of the HR professionals hiring managers all around. English! The chronological format will allow the candidate to showcase his upward mobility in physics materials coursework the career.

It would be useful for specialist mid-level applicants. You must follow the chronological resume when. You have to portray a vertical progression in your career You more or less had a consistent career with no such big work-experience gaps in between You are planning a change of company but in similar trade. Composition With Review! The functional resume format focuses mostly on the skills of the applicant rather than his work experiences. Unlike the conventional chronological format, this one ignores when where the applicant performed or learned those skills. It’s the technology or bad fact that the clep essay review candidate holds those skills relevant to the specific job opening, is highlighted in advancing physics coursework the functional format. The functional format would be useful for clep english composition with essay review you when- You need to create a Fresher Resume Format Templates with no previous work experience but when you are confident about your skills You have big gaps in your career history You are looking forward to promote a particular skill set. Raffle Business Plan! As the english with essay review name suggests, combination resume focuses on plan a fusion of the traditional chronological functional resumes.

Such a resume would usually start with professional profile/summary of qualifications which will include your skills, abilities achievements that are pertinent to clep composition with review the specific job opening you are applying for- it’s for the functional side. The introductory section would be followed by job experience, education (B.E) additional related sections in on career the reverse chronological format. Such a resume would be great when- You are looking forward to highlight a well-developed relevant skill set You have mastered your art You are planning a switch to english essay review another industry. For example, let’s say you are working as an investment banker but you are really good at cartoons or conceptual sketching- such artistic skills would be a wealth for advertising industry in case you are planning to turn your hobbies into your profession. Formatting a resume is no rocket science but you have to be really strategic with the overall planning. As mentioned earlier, the traditional chronological approach is relevant when you are proud of the upward mobility that you have attained in your career. If you are a person with huge or at least some professional experience in photosythesis your industry- the chronological style would be the proper resume format for you. The best resume format for a functional resume strategically groups the key skills abilities of the candidate in various categories to explain his eligibility expertise for some particular job. The skill-based focus will enable you to pull the prospective employer’s attention on clep with essay review your strength which would in is modern or bad turn divert the clep english essay focus from your absent or flawed employment record. For example, let’s say you are applying for the position of a sales manager in a MNC with an international market- and in such a case your functional resume would stress on categories with headings like “team building leadership expertise”, “fluency in foreign languages” etc. In some of cases, the functional resume is completely devoid of the employment history.

Even if it is essay goals in nursing, mentioned, it appears at the very bottom of the resume or in the next page to de-stress on its importance. Clep With Essay! When you are planning a combination resume , you have to is modern technology good essay commence with your key qualifications skills. You can include your career objective, expertise, accomplishments pertinent training relevant to the job application here. Clep Composition Essay Review! The strategy here is to fill up 80-85% of your resume with your skills talents and top rated essay writing service, the rest 15-20 percent would be about your career history. Unlike the clep with review functional resume, you cannot omit your career history here. Goals In Nursing! Make sure it’s easy to read Use bullet points and adequate spacing- single spacing when you are writing about your skills under same category and double-spacing before the start of another category. Use contextual keywords relevant to your job position industry. Clep Essay! Use formal fonts and the font size should be 14 for headings and 12 for the rest. You must use strong verbs such as “managed”, “handled”, “led”, “administered”, “charted” etc. Begin the resume with summary sentence so that the hiring manager can have a blue-print of your skills abilities at good essay a glance. Include personal accomplishments if they are pertinent to the relevant job opening.

Focus on quantifiable accomplishments include facts figures. Composition With! No grammar mistake or typo error is allowed in business plan your resume. Don’t use generic words like hardworking or confident- rather use “efficient at handling big teams for english composition with essay crucial projects”. Don’t use informal email ids in plan contact details. Don’t use chronological resume when you have big gaps in your career.

Don’t include irrelevant personal hobbies. No lengthy resume. Clep English! Don’t lie in your resume and be honest. When you are looking for best resume format examples, we at essay writing service template.net are ready to help you with your expert-designed resumes- whether you need a chronological one or a functional one or a combination resume. Ceative Resume Templates must be drafted using a formal format and a professional tone but it may not be possible for everyone to composition with get it right. Thus one can make use of a resume format.

A resume format is a detailed layout and format of a resume which can be used by those who are confused about the format of such a formal document. A resume format is divided into sections and categories in the exact same way as needed in a resume. It gives the users a reference point of view and idea of essays how a professional Resume Templates must look like. Resume formats may also be provided with the main headings like personal details, academic details, professional experience etc. for better use and clep english with review, reference of the users. What makes a resume format the best resume format is the manner in which it is drafted or framed and how much convenience it offers to the user. It must be time saving for the user to and cellular use and customize and should also be self-explanatory. The following are some of the contents of a resume format which truly make it ‘best’: What is the format of a CV?(100 Words) When it comes to CV, it has to be professional. There are different types of CV possible depending on the purpose of its use and clep composition essay, the expectation of the targeted audiences. Similarly, different types of CVs will have different formats. For example, CV for applying in an IT firm would be different from raffle plan a CV to apply for clep composition with a marketing company.

Instead of taking the risk of designing CV format yourself, it is better to story download for sample CV collection. For example, if you download marketing resume collection, you will get a lot of Marketing Resume Format Templates and english with review, you can choose the best one that appeals to you and fill in the details to send it out. What kind of Resume Should I use?(100 Words) Basically, there are four types of resume available. Is Modern Technology! They are chronological, functional, combinational and clep english with, targeted. Chronological resumes are most commonly used as it represents the data sequentially for top rated writing the employers to find them easily at the very first glance. In case you have some lapse in clep english composition with essay review your work and study, then it is essay on career goals in nursing, better to clep english composition review use a functional resume to cover it up skillfully.

Combinational resume must be used when you are very experienced and your work history matters more than basic data. Targeted resumes are most effective and you need to spend more time preparing it. Business! Download some Basic Resume Format Templates and some samples to make a perfect resume yourself. Which Format do Most Employers Prefer for Resumes? Depending on the job requirement, different employers prefer different resume formats. If the job requirement is for freshers only, employers would like to receive chronological resumes as the data and information about the candidate would be sequentially and clep review, it would be easy to locate required information easily. Raffle Business! But in the case of hiring experienced professionals, employers prefer to have functional resumes where experience and skills get the priority. But in general, employers prefer chronological resume format. Therefore, you need to download different formats like IT Resume Format Templates to apply in IT firm and then based on the job requirements, you have to form the resume that the employers would prefer the clep most. Technology! To write a resume, you have to composition with essay review collect all the required data and information about you in one place. Then you have to download some sample resumes and resume templates as per the purpose of the resume.

For example, if you are applying in an IT firm, you should download IT resumes or if you are applying for a post of HR, you should download HR Resume Format Templates. After downloading them, open them and start filling the raffle business details. Clep Composition With Essay! If there are any unnecessary headings that do not match your profile, you have to essay in nursing omit and delete them. You should refer to sample resume for checking out how exactly to fill the essay review data and information to look impressive. Coursework! what are two of the Most Popular Resume Formats. Out of the english essay review four different types of resumes we listed above, chronological and functional are the most popular resume formats.

Chronological resume formats are popular among freshers or those who have light experience of a couple of years. On the other hand, functional resumes are popular among experienced professionals with at least experience of working in two and more companies. Freshers can also use it in case the is modern technology good essay candidate has diverse skills and has done many internships in english with essay review the past. There are multiple formats available in these two categories and one should download freshers and advancing materials coursework, Experienced Resume Format Templates to have different variations to choose from. A chronological resume is the most used resumes in the world.

In a chronological resume, everything is listed from the recent to clep english composition the earliest format. For example, in story essays academic background, your university degree would come first, followed by the college degree and then at last school qualification. Similarly, in work experience, your recent work would be listed and in clep english with essay the end, you can have your internships. This is the most preferred Writer Resumes format by is modern, the employers as it is easy for composition essay them to get a snapshot of everything very quickly in sad short story their mind. There are various types of chronological formats available and you should download freshers resume format templates to get all the variations and choose the best.

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Queens College English 110: College Comp. Below is an example of an ethnographic essay I wrote as an undergraduate. Notice the english composition with, inclusion of media: please experiment with additional media in your own essay. They hurt you at advancing physics materials coursework home and they hit you at clep composition with essay review school. They hate you if you’re clever, and is modern technology they despise a fool. Till you’re so fucking crazy, you can’t follow their rules. A working class hero is something to clep english composition review, be. –John Lennon, Working Class Hero. The history of the working class man is one that has been constantly neglected in American society. The blue-collar worker, because his life does not have the in nursing, power or wealth of the composition with review, rich, rarely has the opportunity to tell his story.

Instead, our history books are filled with stories of how he and others like him were conquered by the rich and dominant. And since his life has never much been thought of as important in the grand scheme of things, his existence is quickly forgotten once he passes on. The truth of the matter is, however, that his existence and history deserve to on career, be known. He’s a working man, a caring man, and a man who sacrifices his life simply to get by. His story is powerful, moving, and even to an extent, inspirational. Robert Alvarez is your average, run of the mill American of Mexican decent. Clep Composition Review. He was born in a small, working class mining town. Plan. His father was a blue-collar man, as were his grandfathers.

He has worked with his hands his entire life and it is the only kind of work he has known. He knows what it is like to work hard for poor wages, struggle financially, and to surrender himself for clep english composition review the good of his family. And it is because of all this that he is the perfect specimen of raffle plan a blue-collar worker who deserves to have his story known to clep english review, a world that has shunned him and is modern technology good or bad essay his like in the past. I met with Alvarez at his home in the rural farming town of Safford. Clep English. Outside the small house are five cars. Only two actually run. The other three, a badly oxidized, baby blue 1966 Plymouth Satellite, a rusting, navy 1972 Plymouth Duster, and a severely dinged up, silver and black 1979 Dodge Adventurer pickup, are former family cars that the owner hoped to restore after he retired. Now over raffle business plan two years since his departure, they remain in the same spots where they have sat for the last 15 years.

Upon entering the house of the clep english with, retired miner, one is story taken aback by the heap of landscaping tools lying on clep english essay review his front porch. After 36 years working as a copper miner at Phelps Dodge and serving as his family’s primary source of income, the aging man now works as a gardener and takes the back seat as the raffle, money earner to his wife, Anna. Clep English Composition With Review. She works as a public school bus driver by day and in the evening moonlights as a custodian. For Anna, an 11-hour workday is not uncommon. Since Robert’s retirement, however, she no longer has to work alone cleaning the Medical Center of goals Eastern Arizona, the english composition, Arizona State Savings Credit Union, and the Graham County Chamber of goals Commerce. He willingly lends her a hand. “It gives us a chance to spend some time together,” she says. He greets me as I enter and we adjourn to composition with, the dining room table. He offers me a chair next to his. Coursework. I gladly accept.

I notice that the table has an interesting floral arrangement in the center. It appears to have some sort of action figure emerging from the english composition review, middle of it. I take a closer look and realize that it is the black Power Ranger. Alvarez catches me taking a peek at the toy and tells me it belongs to photosythesis, his grandson. “He pretty much runs the place,” he tells me as I crack a smile. I later learn that he was unable to be at the birth of his grandson–his first grandson. He was gone on a two-week detail for the National Guard. As I search my book bag for my tape recorder, Alvarez gets up. English Composition With Essay. “Would you like something to drink? Soda, orange juice, beer?” he asks.

“No thanks,” I tell him. I chuckle at the offer of beer. I think to top rated service, myself how entirely inappropriate it would be to drink an english essay review alcoholic beverage at a time such as this. He returns to physics, the table with what appears to be a 40-ounce bottle of beer. I’m not able to distinguish what variety of beer it is; it’s still covered with the english with, brown paper bag from the liquor store. Top Rated Essay Writing Service. He sets the cap on the table in composition with review front of him and I recognize the Budweiser lid.

Indeed, a truly American beer. Top Rated Essay Writing Service. He sits down in clep english composition essay his chair and leans back “Okay, now I’m ready,” he says right before he takes a big swig of his drink. Alvarez is not like the raffle business plan, average retired copper miner, if one can argue such a thing exists. No, Alvarez is one of clep english with essay those men who you know has battled life from all possible angles. His dark brown eyes tell the story of a man who has seen many a bleak, cold day. His white hair is an indication of his age and acquired wisdom. His dark, weather-beaten skin exemplifies the many hours he has spent working in the sun and sad short essays the laborious work he has subjected his body to for the majority of english with essay his life. Good Or Bad. He lifts up a cigarette and presses it between his lips.

I watch with astonishment as he gracefully picks up his lighter and gently raises it to his face. His big, bulky fingers move with the greatest of ease. They look strong, stronger than, I think to myself, any one of my arms. It’s almost as if they are performing a perfectly synchronized dance, some sort of with essay review warped finger ballet. Technology Or Bad Essay. With his right dancers he grips the red lighter loosely but still firm. His thumb works as the clep english composition review, resistance on the wheel of the photosythesis, lighter and clep with essay with one stroke, a perfect quarter-inch flame is born. Raffle Business Plan. With the cast of his left hand he creates a symmetrical half-dome shield to block any wind from extinguishing the flame. The red glow of the english with essay, burning tip of the unfiltered cigarette glows in the hand wall he has created and technology or bad essay lights up the lower half of his face.

He sets the burning Pall Mall down and takes another big drink of his beer. It doesn’t phase him a bit. He looks at me, “Let’s get this started.” Alvarez was born in Bisbee, Arizona. His father, Francisco Alvarez, a 50-year-old miner and later janitor, married his mother, Maria, when she was 30. English Composition With Essay Review. Robert was the oldest of his father’s new family (he had five other children from a previous marriage). His two brothers, Jim and Ronald, were nothing like their elder sibling. Physics Coursework. Instead of spending most of their time reading classic historical fiction, Jim and clep composition with Ron were behaving like average adolescent boys their age. The differences that distinguished Robert from his two younger brothers grew wider once their father died in 1955. I ask Alvarez if he was thrust into the position of male role model for story his brothers after the death. “Definitely not,” he tells me. He fails to elaborate any more on composition with essay the subject, and raffle business I, instinctively, decide not to follow up on it.

Something tells me not to press too deep into the subject. Clep English Composition With. It appears he is not comfortable speaking of it. I’m disappointed in detecting this, but it is advancing physics obvious there was some sort of clep english composition essay review clash of personalities between the three. To this day, the brothers seldom speak to each other. Little Robert Carlos Alvarez was born on March 14th, 1943. From an raffle early age, he was recognizably intelligent. As a young boy he played the english, violin, excelled in mathematics and science, and read everything he could get his hands on. His favorite tales were those of the chivalrous knights of medieval Europe, but he loved literature from all over the world. Goals. The book case near the entrance of his house is filled with a diverse collection ranging from Dostoyevsky to Dante to the Bhagavad-Gita . He claims to have read the majority of works by these authors by the time he was 20 years of age. These authors gave him a view of a world that was much bigger than Bisbee. Clep With Essay. And because of this, they were his passports to the rest of humanity.

At the age of 17, Alvarez enlisted in the Army. His mother urged him not to leave, but he insisted. He needed to see the world, he told her. All the books he read as a youngster stirred his imagination. From the authors mentioned above, he held the belief that much of the advancing physics materials coursework, people in world were suffering, and, for some time, Alvarez was in his heart a socialist. It wasn’t until the fifth grade, however, that he learned of clep composition with review his socialistic tendencies. “When I was in fifth grade there was a big witch-hunt effort in the US for communists.

They were looking under every rock for them. Well, one day in class, I asked the teacher why some people had to be poor and others did not. I asked her if there was some kind of government that could make everyone the top rated service, same. English Composition. She told me there was and it was called communism. I almost shit! I thought communism was something bad. It really wasn’t bad.

People just didn’t understand it. Is Modern Technology Good Essay. People don’t understand suffering if they never really see it or experience it.” Once in the military, Alvarez’s idea of suffering changed. “It was like the writers wrote but worse, way worse. The worst thing was the hunger. Starvation is a long, horrible process. I saw people dying in front of clep english composition essay me. People living in these starving countries didn’t care about government or politics.

They just wanted to survive. The ordinary people wished the advancing coursework, United States and everyone else would leave them in peace. They didn’t want to be bothered by clep english with essay review political things. Photosythesis. They were more concerned about eating and staying alive.” Upon returning to Bisbee from his military escapade, Alvarez found employment at the local Phelps Dodge mine and began his life following in the footsteps of his father and grandfathers. With Essay Review. He applied for a position on a whim. “Well, I really don’t know why [I applied]. I just did.” For Alvarez the prospects of becoming a laborer for the mine increased when he learned that the man in is modern good essay charge of employment knew his father. “He said ‘I’ll take your application and give you a call. Don’t even bother coming down.’ A couple of clep english essay review days later he called me at home. ‘Come on down here and we’ll get the paperwork’. Easy as that.” The next day, November 21st, 1963, was Alvarez’s first day of his 36-year mining life.

I’m careful not to top rated service, say career when I describe his years of service to english essay review, the mining industry because he claims it not to be a career. “I just thought of it as a job,” he explains as he takes yet another drink from his beverage. “All my life I never worked at a place where I thought of it as a career. I just worked and good made the best of it. A job’s a job. As long as they keep paying me, I don’t give a care.” And Phelps Dodge did continue to pay him. At 20, he was earning close to $500 a month. This was a dramatic increase for him considering he only english composition essay review, made $173 a month in the military. The increase in sad short money prevented Alvarez from clep with essay review, re-enlisting in the army and it kept him for the time being in Bisbee.

The $500 a month wages he received, however, came at a price. Alvarez worked underground for ten years in Bisbee. “It’s the dirtiest work you ever seen,” he tells me. “There’s mud, heat, water. It’s hot.” After hearing this, I question him further and ask him if he could describe in detail what an average day was like for him. He answers me, “a day in Hell.” I think he’s joking and I giggle. Essay Goals In Nursing. Alvarez’s face is clep composition essay review void of physics materials emotion.

He takes another drink from his beer. His time as an underground miner has paid its toll on his health. Even today, 26 years after he left Bisbee, his hearing is very bad and with essay review he smokes a pack of cigarettes a day. Although the smoking may not be directly related with his work in mines, his hearing definitely is. Workers underground were not supplied earplugs by Phelps Dodge when they would operate heavy-duty drills.

Not that the earplugs would have made much difference. He refuses to wear a hearing aid. Story Essays. He prefers that people speak up to him instead. Several times during the course of the interview I had to repeat questions so that he could hear them. Twice during the interview I had to with essay review, speak at very unnatural tones, almost yelling at him. It seemed like my uncomfortableness in doing this humored him. Although Alvarez is not what one would classify as an alcoholic, he obviously enjoys his beer. Again, this can also be contributed to his experience as an underground miner in Bisbee. Everyday, after his shift Alvarez, along with other underground workers, would go directly to the local bar. “The bars would have what they called an after-shift drink, free. You’d go in, and as soon as you got in, they gave you a shot of advancing physics whiskey . . . Of course, they gave it to you so you would start drinking more.

You’d stay in there with the old timers. A lot of us got there at about 3:30. We’d stay there till about 5-6:00. Clep Essay Review. Except for the die-hard ones, they’d stay there half the night. “The miner’s drink was called a boilermaker. It was a shot of whiskey and a beer. Sad Short. We’d have quite a few of those. Composition With Review. You had to keep up with the others, no matter how much of a hangover you had the next day. You had to drink like Hell.

The next day at work you’d damn near die sometimes. But, if you could keep up with them, you were one of advancing physics them. You were a part of them.” Being a part of the underground clique was a major accomplishment for Alvarez. Clep With. The pride is evident in his disposition when he speaks of these miners. His eyes light, and his voice picks up. He produces a smile. He even sets his beer down. It is clear that he cherishes the memories of risking his life working far below the surface with these men. “They were a different breed. They were like the infantry in the Army.

The infantry was supposed to be the story, tough ones who could take anything. That’s what the underground miners were. They could take anything.” As he says this, I feel glad to know that he belonged to something he considers to be special. Not long after that, though, I come to the conclusion that his inclusion in the group was special because it was the first and only time in english with essay review his life when he was able to photosythesis and cellular, live in his Socialist ideal. All the men were equal. There were no rich or poor among them–they were all the clep english, same, all trying to live a simple life. Each person took care of themselves and everyone else. Why it came to be this way, I do not know. Perhaps it was because they saw what he saw and they lived what he lived; they knew each other’s suffering, financial and physical. Maybe it was because they sometimes spent more than 70 hours a week in tight closed spaces together.

Who’s to say, but one thing is for sure: They were blue-collar men destroying their bodies for a company that could care less about them as individuals and essay on career more as a commodity. They were brother-laborers linked together, attempting to clep english composition with essay review, shield themselves from an overbearing parent company. When I think of it like this, Alvarez’s drinking, smoking, and photosythesis and cellular hearing don’t seem like problems to me. I realize that they are only tolls on his body; and that they have not affected his mind in english composition with the least. They may eventually cost him part of raffle business his life, but the clep composition essay, life he has lived has brought the physics, kind of wisdom most of us can only composition with essay review, dream of ever gaining. He knows life and story he knows how the world does and should work. All three are things that many can never find in lifetimes lasting a hundred years.

After 11 years in Bisbee, Alvarez was transferred to english composition review, a new mine in his present home of materials Safford. As for the reason for the move, he says, “I got chosen to come over here. The big producers got chosen, the ones who put out the most tonnage.” Other than the comradeship of working underground, tonnage was another major part in his life as an underground contract miner. Tonnage is a slang term describing the amount of copper a miner digs out. After working up the ladder from an entry laborer, or mucker, he made his way to the alluring money associated with contract mining. Basically, the idea behind contract mining was that teams of clep composition with essay men, usually four per group, would work in split shifts to is modern technology good essay, achieve a company set standard. The standard for the group took several factors of working conditions into consideration. Things like underground temperature, how far ore needed to be moved, how many times ore needed to be moved, how far underground the mining was being done, and if there was the composition with essay, possibility of the shaft caving in essay on career in nursing were all accounted for by the company in its decision of a standard. For Alvarez, a common standard set for his crews was 80 tons per day. Each man was responsible for 20 tons each. If the 80 tons were met, a bonus of 50 cents a ton was awarded by the company for the miners’ hard work.

The system seemed reasonable enough for those motivated to work hard and willing to be part of a team. However, problems often did arise in the arrangement. “Sometimes you got teamed up with some other crew that didn’t want to work.” When this happened, the outcomes often resulted in ill feelings between co-workers. Clep Composition Essay. “It used to get bad to where the day shift guys would go into the bar and start drinking and at eleven o’clock they’d be waiting outside for the other guys to get out. They’d start fighting.” The selection of Alvarez for the Safford mine was a wise one. At one point in his work underground, he was pumping out 25 tons of ore a day.

This is when he says he was making the best money of his young life. Photosythesis. “I was making really good money. That in itself was motivating me to work harder,” he says. The money wasn’t everything, however. Clep English Composition Review. During this time, he met his first wife, Alice. He was 24 and raffle business plan ready to settle down. She was 22 and significantly younger in terms of what she had seen in life compared to him. The two were married March 21st of 1967.

After eight months of composition with review marriage, Alice died during complications in childbirth. Alvarez, destroyed and essay on career goals in nursing distraught, was also out of work. A strike began the with essay review, previous July and in nursing would continue up until the clep with, next April. Goals In Nursing. He remained out of work until then. “It was a bad time in my life,” he says as he takes another drink from his beer. The strike ended quickly after and a few years later, Alvarez met his current wife, Anna.

The two instantly fell in love. Anna had a child from a previous marriage, and when the two married on March 21st, 1970, Alvarez adopted Gilbert Anthony as his own son. “I always thought of him as my boy. He was born the clep with review, same day my wife died.” Two years after their marriage, he and Anna had their first child together, Frederick Robert. Ironically, Fred was born on sad short Gilbert’s birthday, and the fifth anniversary of clep english Alice’s death. With his second child, and happy marriage, things were beginning to look up for Alvarez.

Incidentally, the plan, March 21st wedding of Robert and Anna coincidentally landed on the same day of his first wedding. Both weddings fell on with review a Saturday, Alvarez’s day off from work. From as far as Alvarez could remember, strikes were a regular occurrence at Phelps Dodge mines. “When I first started working in Bisbee, every three years there was a strike. Every three years, never failed.” He pauses to take a drink of his beer. “Every three years the union would call a strike to sad short essays, negotiate contracts.” The union was something Alvarez never cared much for. He held a stereotype of all union members based on his experiences with them.

Part of this stereotype came from his encounters with union representatives who pressured him to join the review, union. “The union guy would come over advancing coursework there and try to sign you up. When you signed up, they finally would leave you alone. As long as you sign, they can take that money out of your paycheck. They used to clep composition, take about $10 out. After that, they don’t bother you and you don’t bother them. I never made a union meeting in on career my life.” Other than the clep with essay review, greed Alvarez saw in unions, the other part of the stereotype he held involved their indolence. “A lot of the union members were the lazy guys,” he says. He claims the and cellular, union also prevented him from outputting tonnage by the number of rules and regulations it set up. “The union used to make up a lot of clep english composition rules that would keep you from photosythesis, making money.” I ask for english composition with essay review an example. “Like at lunchtime. You couldn’t blast more than ten sticks of dynamite because the union members said the smoke would fill up all over and people couldn’t eat in the tunnels.

It would be too much smoke for them. For a lot of the real workers, the smoke would not bother them. Lunch was to eat not enjoy.” Alvarez’s solution to advancing materials coursework, rules and regulations like this was to not get caught. English With Review. “At lunchtime I would use 50 sticks of dynamite but only say I used 10. I wasn’t going to get less tonnage and lose my money for them.” Alvarez was turned in a number of times by the union and was dealt with by PD. “They just told me to stop,” he says.

He didn’t stop, however. “I’d just cool it down for a while. Then, the next chance I got, I would do it again.” Alvarez put up with the union for the next 15 years, but in 1983, the and cellular, shape of clep english essay review unions at Phelps Dodge was undergoing a drastic change. More specifically, the company was in the process of eliminating them. When Alvarez first started working in Safford in April of 1975, a union did not exist at on career goals the mine. “They didn’t have a union in Safford. PD didn’t want a union, so there wasn’t one. The union was still around and real strong in Morenci, though.” Indeed, the union in with essay Morenci was strong and held a considerable amount of influence in the company.

Morenci is a 45-minute drive east of Safford. Photosythesis And Cellular. The town was, and still is, completely controlled by clep english composition review Phelps Dodge. The overwhelming majority of people who live there work for the mine. The union had to be strong in is modern technology good such circumstances. Employees would fight not only for working conditions but also living conditions. Often times, or more accurately, every three years, clashes between the two factions arose. The most heated clash, and the strike which drew enormous national and world attention for composition with review its government-aided striker loss, began July 1, 1983. It eventually ended led to the fall of the union in Morenci. At the time of the strike, Alvarez had moved from the Safford mine, which had been closed in 1982, to a division of small mines being prospected by PD.

However, for the two weeks preceding the strike up to the first day of the strike, he was working in photosythesis Morenci as a loan from small mines. “I was loaned by small mines to Morenci to clean copper out of a furnace. There were a few of us. Clep Composition. We had to drill and top rated essay writing service blast it out. The first day of the strike was the last day I worked in english review Morenci. They asked me if I wanted to stay there after the strike started but I said no. I left the mine, and outside thousands of people were lined up. I didn’t get out of work until 7AM, but they left me alone because they knew I was leaving. If they thought I was a scab, they probably would have killed me. Top Rated Writing. I didn’t want to english with essay review, be a scab. I just wanted to go back to small mines.” Alvarez did go back to small mines, but did not stay there long. “With small mines, PD was trying to look into little, old mines, mining claims all around that had been closed for decades.

They were leasing them looking for essay goals in nursing ore. The first place I went was Gallup, New Mexico. We went around looking in the hills looking for ore. PD thought that the old time prospectors had missed a lot of ore.” PD was wrong. The old prospectors of the area, using only hand tools, cleaned the hills surrounding Gallup of nearly all the ore. “The old miners dug out every little ounce of what there was,” recounts Alvarez. After PD decided small mines was a flop, Alvarez was asked to english composition with essay review, work in Morenci. By this time, the strike was over a year old.

He started in August of 1984. “By that time, there were a lot of openings, and lots of service miners from all over the state were taking the [positions] over.” Demonstrators still lined the gates of the mine, and english with essay review they continued to yell and sad short story essays spit at scabs entering the compound, but Alvarez paid no attention to them. Initially, Alvarez felt compassion for with essay the strikers. “When the strike first started, I felt sorry for the people, that’s why I didn’t stay to work there instead of small mines. Top Rated Essay Service. I didn’t want to take their job away. They were just ordinary workers fighting for their cause.” After he says this, I ask him what caused the relapse in his judgment when he decided to work there a year later. To this he replies, “the people changed. I didn’t feel sorry for them anymore. A lot of the pushy, union strikers ended up going back to english with essay review, work a year later. The one’s who made the most noise were some of the first ones to come back. The strikers were outnumbered.

Most of them went back to work, and they weren’t as solid. They got hungry.” He takes another drink of his beer. Alvarez was called a scab but it did not disturb him a bit. People never approached him during his time off from work or threatened him like they did to other scabs. Sad Short Essays. “I don’t give a damn about people or what they think of me. The strike was broken for all practical purposes and when I went in, I never had anybody come up to me.” Alvarez’s family, however, did feel some anxiety from clep english with, others in the community. On Career In Nursing. One of english with essay review Anna’s closest friends told her over sad short story the telephone one day that she no longer wanted to associate with her ever again. Debbie, Alvarez’s next child after Frederick, claimed to be threatened on english composition with essay the playground many a time at school by advancing coursework children of clep composition with review strikers. Gilbert said his Catechism teacher, a wife of a demonstrator, harassed him. On Career In Nursing. All this did die, however, as the strike came to an end and his life amid the strike that was famous for failing went back to normal.

Reflecting back on the strike, Alvarez takes another drink from his bottle and clep english composition with review says this, “The union was going to break PD. It was too strong. No one was able to work because there were so many rules and regulations. That’s why they got rid of it, and they went into a lot of debt to get rid of it. Looking back on it, though, I think PD had it all planned out for years.

They do need some kind of union, but they don’t need one no near as powerful as that one. Under the new PD, it’s to the point to where they can’t form a union. The still need someone to stick up for advancing physics coursework the ordinary worker. Composition With Review. It was just too powerful at that time. “PD more or less dictates everything now for the worker. But, I think this was planned a long time ago.

One thing about PD, and that’s always been that way, is that they’re going to do what they want to do. It’s take it or leave it. You don’t like it, tough. You either keep working and not like it or you find another job.” Alvarez was able to raise five children and support his wife with his job at Phelps Dodge. He was also able to send three of his kids to college and raffle plan is planning on sending another next fall. He bought a house, 14 cars, and clep english composition with essay review never missed a payment. He built a life with the money he earned at Phelps Dodge. He sacrificed his hands, his lungs, his hearing, and in nursing more especially his liver for a company that paid him poorly for english composition with essay review all he gave. Alvarez never complained about his job and still doesn’t. Advancing Coursework. “I made a living off of english composition with review it. If they go broke tomorrow, I don’t care.

If they went broke when I was working there, I would have found a job somewhere else. Materials Coursework. I never thought of it as a career. I’m not the type of person who is ambitious. I’m not trying to come out ahead. With Essay. I’m just trying to plan, make a life, that’s it.” After Alvarez tells me this, he takes another drink of his beer. Composition With Review. As I watch him, I’m left breathless. I think to myself that the essay, man sitting across from clep english composition essay, me is the living quintessence of top rated essay service what the beaten up workingman is. Composition. He’s been dealt a less than average hand by life, but has been able to make the best of it. He’s a fighter who refuses to give up.

He’s independent and never depended on a union or anyone else to stick up for him. He’s a family man who sacrificed himself to provide. The more I reflect on this, the more I realize that he’s more than just the good guy who has been wronged by sad short story essays life. He’s a hero. But he’s a hero for more than just the workingman. He’s a hero for anyone who knows what it is like to clep composition with, work hard and get paid softly.

He’s a hero for anyone who knows what it is like to combat life from technology or bad essay, all directions. He’s a hero for all those who can relate to the education life gives. I realize that this man deserves to have his story recorded even if he is not as rich as Bill Gates or as powerful as Jess Jackson (both of whom will be remembered in history). Composition With Essay. His story needs to story, be shared, and I’m not just saying that because he’s my father. He’s my hero too.

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How Do the Works of Yasumasa Morimura, Julie Rrap and Anne Zahalka Challenge Conventional Ways in goals Which Gender Has Been Depicted Historically in the Visual Arts? the works of Yasumasa Morimura, Julie Rrap and review Anne Zahalka challenge conventional ways in which gender has been depicted historically in the visual arts ? In your response select at least two different artists and discuss the following: * Through the top rated, postmodern frame of reference, explain how. relate to? That which we have no personal experience from which we can draw upon to clep english with understand what we see? Or perhaps only personal experience with stereotypes or social and essay culture messages from clep composition essay, which to relate an photosythesis image? The result is english composition essay review often what could be described as “otherizing.” That is to writing service say, a sense.

erformance art is a process of using the body as subject matter. The work of art is presented physically to a proactive audience, challenging the traditional values of a static artwork where the audience is english composition with essay passive. The relationship between the artist, artwork and audience is very important and significant. Body Image In American culture, there is goals a lot of emphasis placed on body weight, size, and appearance. And, we are conditioned from clep composition with essay, a very young age to believe that self-worth is derived from these external characteristics. Advancing Physics Materials? For example, being thin and/or muscular is associated with being “hard-working. Lysistrata: a Comedy of Stereotypes. LYSISTRATA, a comedy of stereotypes The playwright Aristophanes wrote about an ancient Greece, Athens in particular, during a time of constant warfare. His play Lysistrata is an attempt to amuse while putting across an anti-war message. In fact even the naming of the play is an anti-war message.

The Classical and the Renaissance Art Periods. famous art periods in history. English Composition With? The Classical period was the time when the Greek and Romans still had their empires and ruled. The Renaissance period was the time when artists broke off from the top rated essay service, Middle Ages and started their own movement. English With Essay Review? The Classical and Renaissance are alike in many of their art styles;.

women today, and it isn't good. In today's society, women are plagued with images of the so-called perfect body ”; this causes many negative effects on and cellular women of clep composition with review today's society. Women—and their body parts—sell everything from food to cars. Materials? Popular film and television actresses are becoming younger, taller. in which society has changed their ways of looking at things, in particular women, have been depicted in artwork for with essay centuries. Raffle Plan? In various forms of clep composition with review art throughout history, women are shown as sex symbols, weak, as servants to men and as housewives, men are depicted as being leaders, masculine, breadwinners. The Holocaust: Effects of Dehumanization in Art Spiegelman’s Maus.

?The Holocaust: Effects of Dehumanization in Art Spiegelman’s Maus War broke out in Europe in September of 1939. Everything went downhill from then, Germans began to take over and minorities such as Jews were quickly forced to go to concentration camps, these horrible camps were stationed all over. Off the Beaten Path: Violence, Women, and top rated essay service Art. CAT event essay 3 For this event, I visited the art exhibit “Off the Beaten Path: violence, women and art ,” and examined how the art pieces connect with the clep english composition with review, CAT class. I found that this particular exhibit connected very well to the gender roles and how sex is viewed in our culture, not only in the. Tabitha Perry Maya Art and Archeology November 7, 2009 The Maya Beliefs Carved in Stone Over the essay writing service, years through Maya art it has become more and more obvious that the with essay review, Maya belief system played a crucial role in their society. In almost every aspect of the Ancient Maya life there is evidence of. Compare and Contrast Arts and Crafts and Art Nouveau 3D Design. ?Compare and Contrast Arts and Crafts and Art Nouveau 3D Design Between 1850 and 1918 there were two movements both in architecture and design who contributed greatly to different methods and styles in on career in nursing their work. These groups were Arts and Crafts and Art Nouveau. While Arts and Crafts were primarily.

after she earned a Degree at the Glasgow school of Art . After completing her education here in 1992 she was offered a six month scholarship at the University of Cincinnati in Ohio,USA. Between 1992 and english composition essay 1993 she also attended the Slade School Of Art . Whilst in Ohio,Saville immersed herself in her surroundings. Influences on good or bad Body Art We have all come across them on the streets or at clep english with review the mall and our reactions and thoughts have been more or less negative. We think to ourselves “how are they able to get a job looking like that?”, or “that must be unpractical and business painful!”. Clep English Composition With Essay Review? Permanent body art marks the.

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Case Study: A Patient With Uncontrolled Type 2 Diabetes and composition review, Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. The specialized role of nursing in the care and education of people with diabetes has been in existence for more than 30 years. Diabetes education carried out by raffle nurses has moved beyond the hospital bedside into a variety of health care settings. Among the disciplines involved in diabetes education, nursing has played a pivotal role in composition essay review, the diabetes team management concept. On Career! This was well illustrated in with, the Diabetes Control and Complications Trial (DCCT) by essay writing the effectiveness of nurse managers in coordinating and clep review, delivering diabetes self-management education. These nurse managers not only performed administrative tasks crucial to photosythesis and cellular the outcomes of the with DCCT, but also participated directly in photosythesis, patient care.1. The emergence and subsequent growth of english composition with, advanced practice in nursing during the past 20 years has expanded the direct care component, incorporating aspects of both nursing and medical care while maintaining the sad short story essays teaching and counseling roles. Both the clinical nurse specialist (CNS) and nurse practitioner (NP) models, when applied to chronic disease management, create enhanced patient-provider relationships in which self-care education and clep english composition review, counseling is provided within the context of disease state management. Clement2 commented in a review of diabetes self-management education issues that unless ongoing management is part of an education program, knowledge may increase but most clinical outcomes only minimally improve. Advanced practice nurses by and cellular the very nature of with essay, their scope of practice effectively combine both education and management into their delivery of care. Operating beyond the role of educator, advanced practice nurses holistically assess patients’ needs with the understanding of raffle, patients’ primary role in the improvement and maintenance of english composition with review, their own health and wellness.

In conducting assessments, advanced practice nurses carefully explore patients’ medical history and business, perform focused physical exams. At the completion of assessments, advanced practice nurses, in conjunction with patients, identify management goals and determine appropriate plans of clep composition with review, care. A review of photosythesis, patients’ self-care management skills and clep english composition with review, application/adaptation to lifestyle is incorporated in initial histories, physical exams, and plans of care. Many advanced practice nurses (NPs, CNSs, nurse midwives, and nurse anesthetists) may prescribe and adjust medication through prescriptive authority granted to them by their state nursing regulatory body. Currently, all 50 states have some form of prescriptive authority for advanced practice nurses.3 The ability to prescribe and adjust medication is photosythesis a valuable asset in caring for individuals with diabetes. It is a crucial component in the care of people with type 1 diabetes, and it becomes increasingly important in the care of clep essay, patients with type 2 diabetes who have a constellation of comorbidities, all of which must be managed for successful disease outcomes. Many studies have documented the raffle business plan effectiveness of advanced practice nurses in managing common primary care issues.4 NP care has been associated with a high level of satisfaction among health services consumers.

In diabetes, the role of advanced practice nurses has significantly contributed to improved outcomes in the management of type 2 diabetes,5 in specialized diabetes foot care programs,6 in the management of diabetes in pregnancy,7 and in the care of pediatric type 1 diabetic patients and their parents.8,9 Furthermore, NPs have also been effective providers of diabetes care among disadvantaged urban African-American patients.10 Primary management of these patients by NPs led to improved metabolic control regardless of whether weight loss was achieved. The following case study illustrates the clinical role of advanced practice nurses in the management of a patient with type 2 diabetes. A.B. is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in 1997, he had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of clep composition with review, 118–127 mg/dl, which were described to him as indicative of “borderline diabetes.” He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries.

At the time of initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken. Referred by plan his family physician to the diabetes specialty clinic, A.B. presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to essay lose weight and increase his exercise for the past 6 months without success. He had been started on on career goals glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and with review, a feeling of mild agitation, in the late afternoon. A.B. Photosythesis And Cellular! also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and a “pancreas elixir” in an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results. He does not test his blood glucose levels at clep composition with review, home and essay service, expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.”

A.B. states that he has “never been sick a day in composition review, my life.” He recently sold his business and has become very active in is modern or bad essay, a variety of volunteer organizations. English Review! He lives with his wife of 48 years and sad short essays, has two married children. Although both his mother and father had type 2 diabetes, A.B. has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to clep composition with treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the story essays Internet for clep english composition with, the latest diabetes remedies. During the past year, A.B. has gained 22 lb.

Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. Good Or Bad Essay! He has never seen a dietitian and has not been instructed in english with essay review, self-monitoring of on career, blood glucose (SMBG). A.B.’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and english with essay review, three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by essay writing pasta. Composition Essay Review! His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening.

He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.” The medical documents that A.B. brings to this appointment indicate that his hemoglobin A 1c (A1C) has never been 8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ?130/80 mmHg for both cardiovascular and renal health.11. A.B. has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years. A physical examination reveals the following: Weight: 178 lb; height: 5?2?; body mass index (BMI): 32.6 kg/m 2. Fasting capillary glucose: 166 mg/dl.

Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg. Pulse: 88 bpm; respirations 20 per minute. Eyes: corrective lenses, pupils equal and reactive to light and plan, accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy. Lungs: clear to auscultation. Heart: Rate and rhythm regular, no murmurs or gallops. Vascular assessment: no carotid bruits; femoral, popliteal, and clep essay, dorsalis pedis pulses 2+ bilaterally.

Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle. Results of on career goals, laboratory tests (drawn 5 days before the office visit) are as follows: Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl) Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl) Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl) Sodium: 141 mg/dl (normal range: 135–146 mg/dl) Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl) • Total cholesterol: 162 mg/dl (normal: 200 mg/dl) • HDL cholesterol: 43 mg/dl (normal: ?40 mg/dl) • LDL cholesterol (calculated): 84 mg/dl (normal: 100 mg/dl) • Triglycerides: 177 mg/dl (normal: 150 mg/dl)

• Cholesterol-to-HDL ratio: 3.8 (normal: 5.0) AST: 14 IU/l (normal: 0–40 IU/l) ALT: 19 IU/l (normal: 5–40 IU/l) Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l) A1C: 8.1% (normal: 4–6%) Urine microalbumin: 45 mg (normal: 30 mg) Based on A.B.’s medical history, records, physical exam, and essay review, lab results, he is assessed as follows: Uncontrolled type 2 diabetes (A1C 7%) Obesity (BMI 32.4 kg/m 2 ) Hyperlipidemia (controlled with atorvastatin)

Peripheral neuropathy (distal and symmetrical by exam) Hypertension (by previous chart data and exam) Elevated urine microalbumin level. Self-care management/lifestyle deficits. • High carbohydrate intake. • No SMBG program.

Poor understanding of diabetes. A.B. Sad Short Story Essays! presented with uncontrolled type 2 diabetes and a complex set of comorbidities, all of composition essay, which needed treatment. The first task of the NP who provided his care was to raffle business select the most pressing health care issues and prioritize his medical care to address them. Although A.B. stated that his need to lose weight was his chief reason for seeking diabetes specialty care, his elevated glucose levels and his hypertension also needed to be addressed at essay, the initial visit. The patient and his wife agreed that a referral to a dietitian was their first priority.

A.B. Raffle! acknowledged that he had little dietary information to help him achieve weight loss and clep composition with essay, that his current weight was unhealthy and “embarrassing.” He recognized that his glucose control was affected by large portions of bread and pasta and agreed to start improving dietary control by reducing his portion size by raffle business one-third during the week before his dietary consultation. Weight loss would also be an important first step in reducing his blood pressure. The NP contacted the registered dietitian (RD) by english with telephone and referred the plan patient for clep english composition, a medical nutrition therapy assessment with a focus on weight loss and improved diabetes control. A.B.’s appointment was scheduled for writing, the following week. The RD requested that during the intervening week, the patient keep a food journal recording his food intake at meals and snacks. She asked that the clep patient also try to estimate portion sizes. Although his physical activity had increased since his retirement, it was fairly sporadic and weather-dependent. After further discussion, he realized that a week or more would often pass without any significant form of and cellular, exercise and that most of his exercise was seasonal. Whatever weight he had lost during the summer was regained in clep english composition with, the winter, when he was again quite sedentary. A.B.’s wife suggested that the two of them could walk each morning after breakfast. She also felt that a treadmill at home would be the best solution for on career, getting sufficient exercise in inclement weather.

After a short discussion about the positive effect exercise can have on glucose control, the patient and his wife agreed to walk 15–20 minutes each day between 9:00 and 10:00 a.m. A first-line medication for this patient had to be targeted to improving glucose control without contributing to weight gain. Thiazolidinediones (i.e., rosiglitizone [Avandia] or pioglitizone [Actos]) effectively address insulin resistance but have been associated with weight gain.12 A sulfonylurea or meglitinide (i.e., repaglinide [Prandin]) can reduce postprandial elevations caused by increased carbohydrate intake, but they are also associated with some weight gain.12 When glyburide was previously prescribed, the patient exhibited signs and symptoms of hypoglycemia (unconfirmed by SMBG). ?-Glucosidase inhibitors (i.e., acarbose [Precose]) can help with postprandial hyperglycemia rise by blunting the effect of the english with essay entry of carbohydrate-related glucose into the system. And Cellular! However, acarbose requires slow titration, has multiple gastrointestinal (GI) side effects, and reduces A1C by clep composition with essay review only 0.5–0.9%.13 Acarbose may be considered as a second-line therapy for top rated, A.B. but would not fully address his elevated A1C results. Composition Essay Review! Metformin (Glucophage), which reduces hepatic glucose production and sad short story essays, improves insulin resistance, is not associated with hypoglycemia and english composition with essay, can lower A1C results by raffle plan 1%. Although GI side effects can occur, they are usually self-limiting and can be further reduced by slow titration to with essay review dose efficacy.14. After reviewing these options and discussing the need for improved glycemic control, the essay goals NP prescribed metformin, 500 mg twice a day. Clep Composition! Possible GI side effects and the need to avoid alcohol were of concern to A.B., but he agreed that medication was necessary and that metformin was his best option. The NP advised him to take the medication with food to reduce GI side effects.

The NP also discussed with the patient a titration schedule that increased the dosage to 1,000 mg twice a day over a 4-week period. She wrote out this plan, including a date and time for telephone contact and medication evaluation, and gave it to the patient. During the visit, A.B. and his wife learned to raffle use a glucose meter that features a simple two-step procedure. The patient agreed to use the meter twice a day, at breakfast and dinner, while the metformin dose was being titrated. Essay Review! He understood the need for glucose readings to guide the sad short story essays choice of medication and to evaluate the effects of his dietary changes, but he felt that it would not be “a forever thing.” The NP reviewed glycemic goals with the patient and his wife and english composition with essay, assisted them in top rated essay service, deciding on initial short-term goals for weight loss, exercise, and medication.

Glucose monitoring would serve as a guide and english composition with review, assist the patient in modifying his lifestyle. A.B. drew the line at starting an antihypertensive medication—the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec), 5 mg daily. He stated that one new medication at a time was enough and that “too many medications would make a sick man out of me.” His perception of the technology or bad essay state of his health as being represented by the number of medications prescribed for him gave the advanced practice nurse an clep english composition with essay, important insight into the patient’s health belief system. The patient’s wife also believed that a “natural solution” was better than medication for treating blood pressure. Although the use of an ACE inhibitor was indicated both by the level of is modern technology essay, hypertension and by the presence of microalbuminuria, the decision to wait until the english with essay next office visit to further evaluate the need for antihypertensive medication afforded the patient and essay service, his wife time to consider the importance of adding this pharmacotherapy. They were quite willing to english composition with review read any materials that addressed the prevention of physics materials coursework, diabetes complications. Clep Composition With Review! However, both the patient and his wife voiced a strong desire to focus their energies on changes in food and and cellular, physical activity. The NP expressed support for their decision.

Because A.B. was obese, weight loss would be beneficial for many of his health issues. Because he has a sedentary lifestyle, is with 35 years old, has hypertension and peripheral neuropathy, and is being treated for hypercholestrolemia, the NP performed an electrocardiogram in and cellular, the office and referred the patient for an exercise tolerance test.11 In doing this, the NP acknowledged and review, respected the mutually set goals, but also provided appropriate pre-exercise screening for goals in nursing, the patient’s protection and safety. In her role as diabetes educator, the NP taught A.B. and clep english composition review, his wife the importance of foot care, demonstrating to the patient his inability to feel the light touch of the monofilament. She explained that the loss of protective sensation from peripheral neuropathy means that he will need to be more vigilant in checking his feet for any skin lesions caused by poorly fitting footwear worn during exercise. At the conclusion of the visit, the NP assured A.B. Sad Short Essays! that she would share the clep english with review plan of essay on career goals in nursing, care they had developed with his primary care physician, collaborating with him and discussing the findings of any diagnostic tests and procedures.

She would also work in partnership with the RD to reinforce medical nutrition therapies and improve his glucose control. In this way, the NP would facilitate the continuity of care and keep vital pathways of communication open. Advanced practice nurses are ideally suited to play an clep english composition essay review, integral role in the education and medical management of people with diabetes.15 The combination of clinical skills and essay on career goals, expertise in teaching and counseling enhances the english with essay review delivery of care in a manner that is both cost-reducing and effective. Inherent in the role of advanced practice nurses is the understanding of goals in nursing, shared responsibility for health care outcomes. This partnering of nurse with patient not only improves care but strengthens the patient’s role as self-manager. Geralyn Spollett, MSN, C-ANP, CDE, is associate director and an adult nurse practitioner at the Yale Diabetes Center, Department of Endocrinology and Metabolism, at Yale University in New Haven, Conn. Clep English Essay! She is an associate editor of Diabetes Spectrum.

Note of disclosure: Ms. Photosythesis And Cellular! Spollett has received honoraria for speaking engagements from Novo Nordisk Pharmaceuticals, Inc., and Aventis and clep english essay, has been a paid consultant for Aventis. Is Modern Good! Both companies produce products and devices for the treatment of diabetes. 2017 by the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353 .