DIRECTIONS: Complete the sentences using the words in the box. astonishing disturb factor invisible layer They are in a meeting with their clients at the moment; please do not ____________________ them unless it is very important. [BLANK-1]

DIRECTIONS: Complete the concept map below with words from the passage.One of the best places in the world to see a natural light show is Vieques, a small island that belongs to Puerto Rico. The island is famous for its bahía bioluminiscente, or “bio bay” – home to countless dinoflagellates. These dust-size beings are named for their two flagella 5 and the whirling motion they make ( dinos means “whirling” in Greek). Dinoflagellates light up whenever the water around them moves; they are the organisms typically responsible for the flashes of light you sometimes see when swimming or boating on a dark night. Visitors to Vieques can join an evening tour group and set out across the bay in transparent canoes. The island has only a few streetlights, so when the moon is not yet risen, the sea is dark and the sky is full of stars. Fish dart through the water, looking like meteors. Eventually, the movement of the canoes disturbs the dinoflagellates, and they light up in a bright, flickering stream. Watching them through the canoe’s transparent floor can give a powerful impression that the water is part of the sky, and you are paddling through the stars. nar002-1.jpg (2) ____________________ [BLANK-1]

DIRECTIONS: Choose the best answer for each question. Living Light [A] The ability of some species to create light – known as bioluminescence – is both magical and commonplace. Magical, because of its glimmering beauty. Commonplace, because many life forms can do it. On land the most familiar examples are fireflies, flashing to attract mates on a warm summer night. But there are other luminous land organisms, including glow-worms, millipedes, and some 90 species of fungus. Even some birds, such as the Atlantic puffin, have beaks that glow in the dark. [B] But the real biological light show takes place in the sea. Here, an astonishing number of beings can make light. Some, such as ostracods, are like ocean fireflies, using flashes of light to attract a mate. There are also glowing bacteria, and light-making fish, squid, and jellyfish. Indeed, of all the groups of organisms known to make light, more than four-fifths live in the ocean. [C] As a place to live, the ocean has a couple of peculiarities. Firstly, there is almost nowhere to hide, so being invisible is very important. Secondly, as you descend, sunlight disappears. At first, red light is absorbed. Then the yellow and green parts of the spectrum disappear, leaving just the blue. At 200 meters below the surface, the ocean becomes a kind of perpetual  twilight, 1 and at 600 meters the blue fades out too. In fact, most of the ocean is as black as the night sky. These factors make light uniquely useful as a weapon or a veil. Hiding with Light[D] In the ocean’s upper layers, where light penetrates, creatures need to blend in to survive. Any life form that stands out is in danger of being spotted by predators – especially those swimming below, looking up. Many life forms solve this problem by avoiding the light zone during the day. Others – such as jellyfish and swimming snails – are transparent, ghostlike creatures, almost impossible to see. [E] Other sea species use light to survive in the upper layers – but how? Some, such as certain shrimp and squid, illuminate their bellies to match the light coming from above. This allows them to become invisible to predators below. Their light can be turned on and off at will – some even have a dimmer switch. 2 For example, certain types of shrimp can alter how much light they give off, depending on the brightness of the water around them. If a cloud passes overhead and briefly blocks the light, the shrimp will dim itself accordingly. [F] But if the aim is to remain invisible, why do some creatures light up when they are touched, or when the water nearby is disturbed? A couple of reasons. First, a sudden burst of light may startle 3 a predator, giving the prey a chance to escape. Some kinds of deep-sea squid, for example, give a big squirt of light before darting off into the gloom. [G] Second, there is the principle of “the enemy of my enemy is my friend.” Giving off light can help summon the predator of your predator. Known as the “burglar alarm” effect, this is especially useful for tiny life forms, such as dinoflagellates, that cannot swim fast. For such small beings, water is too viscous 4 to allow a quick getaway – it would be like trying to swim through syrup. Instead, when threatened by a shrimp, for example, these organisms light up. The flashes attract larger fish that are better able to spot – and eat – the shrimp. The chief defense for these tiny organisms is therefore not fight or flight – but light. STARS OF THE SEAOne of the best places in the world to see a natural light show is Vieques, a small island thatbelongs to Puerto Rico. The island is famous for its bahía bioluminiscente, or “bio bay” – home to countless dinoflagellates. These dust-size beings are named for their two flagella5 and the whirling motion they make (dinos means “whirling” in Greek). Dinoflagellates light up whenever the water around them moves; they are the organisms typically responsible for the flashes of light you sometimes see when swimming or boating on a dark night.Visitors to Vieques can join an evening tour group and set out across the bay in transparentcanoes. The island has only a few streetlights, so when the moon is not yet risen, the sea is dark and the sky is full of stars. Fish dart through the water, looking like meteors. Eventually, the movement of the canoes disturbs the dinoflagellates, and they light up in a bright, flickering stream. Watching them through the canoe’s transparent floor can give a powerful impression that the water is part of the sky, and you are paddling through the stars. 1 Twilight is the time of day after the sun sets but before it becomes completely dark. 2 A dimmer switch is a device – such as those found on lamps – that can control the brightness of a light. 3 If something startles you, it causes you to feel surprised or shocked. 4 A liquid that is viscous is thick and not easy to move through. 5 Flagella are thin, threadlike structures that enable tiny organisms such as bacteria or protozoa to swim. Bioluminescence in life forms ____.

DIRECTIONS: Complete the concept map below with words from the passage.One of the best places in the world to see a natural light show is Vieques, a small island that belongs to Puerto Rico. The island is famous for its bahía bioluminiscente, or “bio bay” – home to countless dinoflagellates. These dust-size beings are named for their two flagella 5 and the whirling motion they make ( dinos means “whirling” in Greek). Dinoflagellates light up whenever the water around them moves; they are the organisms typically responsible for the flashes of light you sometimes see when swimming or boating on a dark night. Visitors to Vieques can join an evening tour group and set out across the bay in transparent canoes. The island has only a few streetlights, so when the moon is not yet risen, the sea is dark and the sky is full of stars. Fish dart through the water, looking like meteors. Eventually, the movement of the canoes disturbs the dinoflagellates, and they light up in a bright, flickering stream. Watching them through the canoe’s transparent floor can give a powerful impression that the water is part of the sky, and you are paddling through the stars. nar002-1.jpg (4) ____________________ [BLANK-1]

DIRECTIONS: Complete the concept map below with words from the passage.One of the best places in the world to see a natural light show is Vieques, a small island that belongs to Puerto Rico. The island is famous for its bahía bioluminiscente, or “bio bay” – home to countless dinoflagellates. These dust-size beings are named for their two flagella 5 and the whirling motion they make ( dinos means “whirling” in Greek). Dinoflagellates light up whenever the water around them moves; they are the organisms typically responsible for the flashes of light you sometimes see when swimming or boating on a dark night. Visitors to Vieques can join an evening tour group and set out across the bay in transparent canoes. The island has only a few streetlights, so when the moon is not yet risen, the sea is dark and the sky is full of stars. Fish dart through the water, looking like meteors. Eventually, the movement of the canoes disturbs the dinoflagellates, and they light up in a bright, flickering stream. Watching them through the canoe’s transparent floor can give a powerful impression that the water is part of the sky, and you are paddling through the stars. nar002-1.jpg (3) ____________________ [BLANK-1]

The following code has no race condition.

Initial Post on Disseminated Intravascular Coagulation (DIC) Introduction Disseminated intravascular coagulation, which is more commonly known as DIC, is a rare, life-threatening disorder that is characterized by both the formation of blood clots and random bleeding episodes in patients who are critically ill (Capriotti, 2020). The clotting episodes can cause blood flow to be cut off to the organs as well as multiple organ dysfunction syndrome, which is also known as MODS (Capriotti, 2020). The bleeding episodes put the patient at risk for hemorrhage, which can be fatal. The course of treatment for DIC patients is completely dependent upon what underlying disease caused the DIC.  Epidemiology and Risk Factors Disseminated intravascular coagulation always occurs secondary to either one or several comorbid conditions, and it can occur acutely or develop into a chronic condition depending on what triggered it (Adelborg et al., 2021; Smith, 2021). There are several types of conditions that can trigger DIC, and they include cancers, blood conditions, infections, obstetric conditions, trauma or major surgery, and various forms of shock (Capriotti, 2020, p. 322). Within those categories, some conditions that put people at a higher risk of developing DIC are leukemia, metastatic cancers, acute viral infections, parasitic infections, burns, heatstroke, massive trauma, and sepsis (Capriotti, 2020, p. 322; Popescu et al., 2022). Women who experience conditions like abruptio placenta, eclampsia or preeclampsia, or amniotic fluid embolism during pregnancy or childbirth are also at a high risk of developing DIC (Capriotti, 2020). Of the conditions listed, the most common trigger of DIC is sepsis, with the disorder occurring in 30 to 50 percent of sepsis patients (Capriotti, 2020). Additionally, the mortality rate in patients who experience DIC secondary to a massive trauma is double what it is for those who do not develop it (Capriotti, 2020). This condition can develop in people of any race, and there is no gender bias. It occurs in males just as much as it does in females (Capriotti, 2020).  Etiology  DIC involves several different pathways and mechanisms in the body, which is what makes the disorder so difficult to identify and treat in time. Mainly, DIC affects the body’s ability to regulate the production of thrombin, the suppression of anti-clotting mechanisms, and the abnormal dissolving of blood clots (Capriotti, 2020; Smith, 2021). In the beginning stages of DIC, the body continuously receives stimulation to clot from procoagulant factors. As more clots form, the body depletes platelets and clotting factors, which results in excessive bleeding once the clots are dissolved (Smith, 2021). The process of excessive clotting and then excessive bleeding repeats itself until systems in the body start to be affected.  Clinical Manifestations Patients who experience disseminated intravascular coagulation may present with different symptoms, which are all dependent upon the underlying cause of the DIC (Papageorgiou et al, 2018). These patients may have petechiae or purpura on their skin, which are spots that resemble a rash that show up when blood vessels are leaking (Capriotti, 2020). Patients may also present with open wounds that are oozing blood or uncontrolled bleeding that is internal in nature or in the gums (Capriotti, 2020). Other signs and symptoms include cyanosis in the distal extremities due to lack of blood flow, limb ischemia, and gangrene (Capriotti, 2020). Shock is also common in those with DIC, and it can cause multiple organ failure or death if it is not treated in a timely manner. If the bleeding reaches the brain, it can cause severe neurological deficits, confusion, coma, or death (Capriotti, 2020). These patients will also have a depleted platelet count.  Diagnosis and Treatment Diagnosing and treating DIC can be very difficult due to the variety of causative conditions that all come with their own sets of symptoms. When a patient is being tested to confirm a DIC diagnosis, the blood will be evaluated for abnormal values of platelets, fibrinogen, activity time for antithrombin, and more (Adelborg et al., 2021). Additionally, the D-dimer test is “the most sensitive test for DIC” and an elevation demonstrates fibrinolysis (Capriotti, 2020). After a diagnosis is confirmed, treatment must start. The main goals in treating DIC are controlling the underlying causative disease, replacing clotting factors with blood transfusions, and preventing too much clotting (Capriotti, 2020). If the causative disease or condition is acute and reversible, DIC can also be reversed with the correct treatment. If the causative disease is chronic or incurable, DIC is most likely a fatal condition. In instances of significant clotting, heparin, which is an anticoagulant medication, can be given to interrupt the body’s clotting process (Capriotti, 2020). Although it can be difficult, recognizing certain symptoms, running diagnostic tests, and quickly intervening on behalf of a patient with DIC is crucial in increasing their chances of survival.  Conclusion In conclusion, disseminated intravascular coagulation, or DIC, is a rare, life-threatening condition that affects the body’s coagulation abilities. “It occurs in one percent of all hospitalized patients”, and it always occurs secondary to a causative disease or condition (Capriotti, 2020, p. 306). These patients present with many different symptoms, but the main symptoms to look out for involve uncontrollable bleeding or bleeding for no apparent reason. It is very important for patients with DIC to receive medical attention immediately in order to reverse the effects of the causative disease, if possible, and improve their chances of survival.   References Adelborg, K., Larsen, J. B., & Hvas, A. M. (2021). Disseminated intravascular coagulation: Epidemiology, biomarkers, and management. British Journal of Haematology, 192(5), 803-818. https://doi.org/10.1111/bjh.17172Links to an external site. Capriotti, T. (2020). Davis advantage for pathophysiology: Introductory concepts and clinical perspectives (2nd ed.). F.A. Davis. Papageorgiou, C., Jourdi, G., Adjambri, E., Walborn, A., Patel, P., Fareed, J., Elalamy, I., Hoppensteadt, D., & Gerotziafas, G. T. (2018). Disseminated intravascular coagulation: An update on pathogenesis, diagnosis, and therapeutic strategies. Clinical and Applied Thrombosis/Hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 24(9_suppl), 8S–28S. https://doi.org/10.1177/1076029618806424Links to an external site. Popescu, N. I., Lupu, C., & Lupu, F. (2022). Disseminated intravascular coagulation and its immune mechanisms. Blood, The Journal of the American Society of Hematology, 139(13), 1973-1986. https://doi.org/10.1182/blood.2020007208Links to an external site. Smith, L. (2021, April). Disseminated intravascular coagulation. Seminars in Oncology Nursing (Vol. 37, No. 2, p. 151135). WB Saunders. https://doi.org/10.1016/j.soncn.2021.151135

Initial Post on Types of Thrombocytopenia Introduction Thrombocytopenia is a disease that is characterized by a low amount or abnormal functionality of platelets in the blood. A deficiency of platelets in the blood is defined as less than 150,000 platelets per microliter (National Heart Lung and Blood Institute, 2022). Due to this deficiency, the blood does not clot properly and there can be issues with excessive bleeding. The body’s platelet count can diminish due to problems with the production mechanisms, destruction of platelets in the bloodstream or by organs such as the spleen and liver. There are several different types of thrombocytopenia, each with different etiologies and treatments. These types include Thrombotic Thrombocytopenic Purpura (TTP), Drug-Induced Thrombocytopenia (DIT), Heparin-Induced Thrombocytopenia (HIT), and Immune Thrombocytopenia (ITP). These types of thrombocytopenia are all related because they involve a deficiency of blood platelets. Etiology and Genetic Risk Thrombotic Thrombocytopenic Purpura (TTP) is caused by small blood clots that block blood flow to the major organs of the body. The specific etiology of TTP originates from a deficiency of the enzyme ADAMTS13 that regulates the production of blood clots (National Heart, Lung and Blood Institute, 2022). This deficiency can be genetically passed down, or the enzyme can be destroyed by infection from a different disease, causing an excess amount of blood clots to stop blood flow which can create problems with organ function. The spleen is typically the organ responsible for destroying the ADAMTS13 enzyme (National Heart Lung and Blood Institute, 2022). Drug-Induced Thrombocytopenia (DIT) is caused by drugs that destroy platelets or prevent their production. These drugs can be medications that are meant to help with another disease, but cause clotting issues as side effects. The most common type of DIT is Heparin-Induced Thrombocytopenia (HIT), according to Gersten, 2022. HIT is caused by intake of heparin. Heparin is a blood thinner that specializes in decreasing the formation of blood clots. “HIT is caused by platelets clumping due to an immune reaction to heparin. The clumping uses them up and lowers the count” (EBSCO Medical Review Board, 2022). Although heparin is supposed to decrease the risk of blood clots, with HIT the heparin can cause a severe increase in blood clot production (EBSCO Medical Review Board, 2022). Immune Thrombocytopenia (ITP), is a disorder where the immune system malfunctions and makes antibodies that destroy platelets instead of protecting them. Platelets are usually destroyed in organs such as the spleen and liver, as well as the bone marrow (Schub, 2018). There are two types of ITP, acute and chronic. According to Schub (2018), acute ITP often affects children, whereas chronic ITP is more common in adults. Those with autoimmune disorders or prior infections are more susceptible to ITP.  Physical Assessment/Clinical Manifestations The symptoms of each type of thrombocytopenia are similar in some respects, but they differ slightly. With Thrombotic Thrombocytopenic Purpura, severe bruising (called purpura) is common, along with minor, smaller bruises (petechiae). Fever, nausea, fatigue, headaches, high heart rate, jaundice and blood in the urine are other possible symptoms (National Heart Lung and Blood Institute, 2022). For Drug-Induced Thrombocytopenia, the symptoms include purpura and petechiae, as well as “abnormal bleeding” (Gersten 2021). With Heparin Induced Thrombocytopenia, the symptoms of DIC apply, as well as having a list of its own symptoms. These include hypertension, tachycardia, chest pain, coughing and wheezing, fever and pain or swelling in the extremities (Gersten 2021). The symptoms of Immune Thrombocytopenia include “purpura, menorrhagia, epistaxis, gingival bleeding, dependent region petechiae, and retinal hemorrhages” (Schub 2018). All the types of thrombocytopenia mentioned include some form of bruising and excessive bleeding as symptoms. Hemorrhage can be a serious complication to this disease because of the blood’s inability to clot.  Clinical Practice Standards In order to diagnose thrombocytopenia, a complete blood count (CBC) must be ordered to confirm the number of platelets in the blood, as well as blood clotting tests such as PTT and PT (Gersten, 2022). TTP can be diagnosed by ordering an ADAMTS13 assay to determine the status of the ADAMTS13 enzyme. Other tests include bilirubin, bone marrow, kidney function and urine tests (National Heart Lung and Blood Institute, 2022). Treatment for TTP includes plasma treatments such as plasmapheresis and plasma infusion, as well as surgeries such as a splenectomy. Medications, such as corticosteroids, can also be used to treat TTP. For DIT and HIT, the diagnosis just includes the blood tests previously mentioned. In addition to those blood tests, a PF4 antibody test is also an effective way to diagnose these types of thrombocytopenia. With regards to treatment, the easiest way to treat these types of thrombocytopenia is to stop taking the medication causing the blood platelets to diminish (Gersten, 2021). ITP can be diagnosed by ordering an MAIPA assay, CBC, coagulation studies, and bone marrow analysis on patients over 60 years of age (Schub 2018). Treatments for ITP include platelet transfusions, medications, or a splenectomy. These treatments are similar to the other types of thrombocytopenia because each type causes the same deficiency of platelets. To determine effective treatment, however, it is crucial that a healthcare provider choose whether to treat the cause or the effect (or both) of the disease. Conclusion Thrombocytopenia is a blood disorder that involves a deficiency of blood platelets. Due to this deficiency, blood clots are unable to form, causing excessive bleeding, bruising and other, possibly fatal, complications. The different types of thrombocytopenia are thrombotic thrombocytopenic purpura, drug-induced thrombocytopenia, heparin-induced thrombocytopenia and immune thrombocytopenia.  References EBSCO Medical Review Board. (2022, February 1). Heparin-induced Thrombocytopenia.  EBSCOhost. Retrieved March 4, 2023, from https://web-s-ebscohost-com.ezproxy.fhu.edu/nup/detail/detail?vid=0&sid=7155934c-c146-41d6-b2dd-4d1877dbeb8d%40redis&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=nup&AN=2010319632&anchor=ID0E2Links to an external site.  Gersten, T. (2021, July 22). Drug-Induced Thrombocytopenia. Medline Plus. Retrieved March 4,  2023, from https://medlineplus.gov/ency/article/000556.htmLinks to an external site.  Gersten, T. (2022, January 25). Thrombocytopenia. Medline Plus. Retrieved March 4, 2023, from  https://medlineplus.gov/ency/article/000586.htmLinks to an external site.  Kuter, D. (2022). Overview of Platelet Disorders. Merck Manual. Retrieved March 4, 2023, from  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/overview-of-platelet-disorders?query=thrombocytopeniaLinks to an external site.  National Heart Lung and Blood Institute. (2022, March 24). Platelet Disorders. Retrieved March 4,  2023, from https://www.nhlbi.nih.gov/health/thrombocytopeniaLinks to an external site.  Schub, T. (2018, February 23). Immune Thrombocytopenia. EBSCOhost. Retrieved March 4,  2023, from https://web-s-ebscohost-com.ezproxy.fhu.edu/nup/detail/detail?vid=0&sid=9e64197f-b348-426e-81ba-38eeb62ec2cd%40redis&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T702280&db=nupLinks to an external site. 

A nurse is providing care to a client who is preparing to go to surgery. Which of the following manifestations should the nurse expect in a client who experiencing a stress response?

A nurse is caring for a client who is withdrawn. Which of the following responses is an example of thetrauma-informed care approach?