The Great Gatsby By F. Scott Fitzgerald - 1163 Words

Do people think Jay Gatsby truly loves Daisy Buchanan or her wealth? In The Great Gatsby, a book written by F. Scott Fitzgerald, it explores the love fantasies and realities through the character Jay Gatsby. Most of the characters in The Great Gatsby employ others for their own benefits, including the hero Jay Gatsby. Jay Gatsby was a very poor man when he met Daisy five years before. It is clearly shown in the book that Gatsby adores Daisy’s wealth and the way that she uses it. This is proven when Gatsby asserts to Nick Carraway, the narrator of this novel, that â€Å"Her voice is full of money† (Fitzgerald, 120). He always considered Daisy to be represented as the epitome of wealth and respect. This is the reason for Gatsby’s desire for†¦show more content†¦James Gatz changed his name to Jay Gatsby, since he wish for a new identity to reflect his new lifestyle. He runs away from his home to seek his fortune. He go to Saint Olaf’s college and dis like having to work as a janitor to pay for his studies, therefore he leaves after two months. Soon afterward she meets with a millionaire named Dan Cody, who is on his yacht at Lake Superior and he turns into Cody’s best friend and his right-hand man for five years. Unfortunately, Cody was a heavy drinker and he dies. Cody left Gatsby with money, yet he never obtains the money, hence leaving him broke. Later, Gatsby meet with Daisy and believes that he will attain his dream through Daisy. As a young officer during World War I, Gatsby admire Daisy greatly because she represents wealth and the life that he has always wanted. He falls deeply in love with her and since, he is aware that being rich is salient for Daisy, as a result, Gatsby determines to become a wealthy man. While, Gatsby leave to go fight in the war, soon Daisy becomes tired of waiting for Gatsby and as a result, she decides to marry Tom Buchanan, who is a very wealthy man. Meanwhile Gatsby lives in a strange il lusion that he and Daisy will reunite soon. Later he finds out about her marriage, leaving him heartbroken. However, he becomes really wealthy and gains money through illegal means. He gains millions and buys a mansion across the bay from Daisy’s house. Gatsby hosts lavish

The Love Song Of J. Alfred Prufrock - 1051 Words

â€Å"The Love Song of J. Alfred Prufrock† by T.S. Eliot is not a love song at all—but an insight into the mind of an extremely self-conscious, middle-aged man. Prufrock struggles in coping with the world he is living in—a world where his differences make him feel lonely and alienated. Eliot uses allusions and imagery, characterization, and the society Prufrock lives in to present how Prufrock partly contributes to his own alienation. Our ability of self-awareness separates us from other species, making humans more intelligent and giving people the upper hand in social settings, but, like Prufrock, it can sometimes cause us to feel alienated. Eliot uses allusions and imagery to make several references to characters—both real and fictional—to vicariously show how Prufrock feels. The first allusion is an epigraph from Dante’s Inferno: If I believed that my response was heard by anyone returning to the world, this flame would stand and never stir again. But since no man has ever come alive out of this gulf of Hell, if I hear true, I’ll answer, with no fear of infamy. (Eliot) This allusion shows how Prufrock, like Guido da Montefeltro, is in his own hell. Feeling alienated and fearing social rejection, Prufrock compares himself to John the Baptist: â€Å"But though I have wept and fasted, wept and prayed / Though I have seen my head (grown slightly bald) brought in upon a platter, / I am no prophet† (Eliot 81-83). Prufrock imagining his head on a platter is representative of his fearShow MoreRelatedThe Love Song Of J. Alfred Prufrock1647 Words   |  7 Pagesseen in T.S. Eliot’s work The Love Song of J. Alfred Prufrock. The main character, Prufrock, plans to ask the woman he loves the overwhelming question of marriage, but due to his pessimistic outlook, he became hesitant and self conscious. Surges of insecurity arise, and instead of proposing his love, Prufrock delays the question and spends the night talking nonsense to avoid the situation. In the end, Prufrock’s insecurities and fear of rejection alter his feelings of love into a sense of emotional protectionRead MoreThe Love Song Of J. Alfred Prufrock970 Words   |  4 PagesNever in Love When reading the title of T.S Eliot’s â€Å"The Love Song of J. Alfred Prufrock† it is believed we are in store for a poem of romance and hope. A song that will inspire embrace and warmth of the heart, regretfully this is could not be further from the truth. This poem takes us into the depths of J. Alfred Prufrock, someone who holds faltering doubt and as a result may never come to understand real love. â€Å"The Love Song of J. Alfred Prufrock† takes us through Prufrock’s mindset and his self-doubtingRead MoreThe Love Song Of J. Alfred Prufrock1072 Words   |  5 Pages We may never be given a second chance to do something daring ever again so we seize the day! However, people like in J. Alfred Prufrock make the attempt to do but it doesn’t work. â€Å"The Love Song of J. Alfred Prufrock,† written by T.S. Elliot, essentially is about a simple man that wishes to ask a question, although the question is never revealed, the reader is taken on journey the with the speaker, only to find that they have spent a lengthy amount of time of their lives without ever asking theRead MoreThe Love Song Of J. Alfred Prufrock Essay1928 Words   |  8 PagesHuman Voices Wake Us and We Drown’: Community in ‘The Love Song of J. Alfred Prufrock’,† James Haba contends that the repeated use of â€Å"you†, â€Å"we†, and â€Å"us† in T. S. Eliot’s â€Å"The Love Song of J. Alfred Prufrock† creates a personal ambience around the reader and Prufrock. Because of this, Haba argues that Eliot’s use of personal pronouns and references produces a sense of community and intimacy between the reader and Prufrock (53), even though Prufrock seemingly struggles with emotions of intimacy andRead MoreThe Love Song Of J. Alfred Prufrock915 Words   |  4 PagesThe Love Song of Alfred Prufrock: Taking the Love out of Song A tragedy in a poem is usually characterized as an event that has a tragic or unhappy ending. They generally are used to teach morals or lessons. T.S. Eliot’s, â€Å"The Love Song of J. Alfred Prufrock†, is considered a tragedy because of the way Eliot uses four different writing styles: word choice, figurative language, images, and biblical allusions. Using these styles, Eliot acknowledges the tragic endeavor of single, reclusiveRead MoreThe Love Song of J. Alfred Prufrock1729 Words   |  7 PagesThe Love Song of J. Alfred Prufrock The dramatic monologue â€Å"The Love Song of J. Alfred Prufrock was written by Thomas Stearns Eliot and published in June of 1915. Eliot was born in St Louis, Missouri on September 26, 1888, where he grew up and lived until the age of eighteen. After high school, Eliot studied at Harvard University in Cambridge, MA and the Sorbonne in Paris, France. Eventually, Eliot ended up in England where he married his wife Vivien and spent the remainder of his lifeRead MoreThe Love Song Of J. Alfred Prufrock1125 Words   |  5 Pagesmodernism. The Love Song of J. Alfred Prufrock, despite being one of T.S Eliot s earliest publications, still manages to remain one of the most famous. He uses this poem to not only draw out the psychological aspect of members of modern society, but also to draw out the aspect of the time that he lived in. The speaker of this poem is a modern man who feels alone, isolated, and incapable of making decisive actions for himself. Prufrock desires to sp eak to a woman about his love for her, but heRead MoreThe Love Song Of J. Alfred Prufrock986 Words   |  4 PagesIn The Love Song of J. Alfred Prufrock by T. S. Eliot and Dover Beach by Matthew Arnold the poets utilizes poetic devices to convey their respective themes. Through use of symbols and metaphors, the speaker in The Love Song of J. Alfred Prufrock displays his fears of the changes brought with the younger generation, and isolation from the changing society. The speaker in Dover Beach, utilizes symbols, metaphors, and similes to state that the younger generation has less faith than the older, and societyRead MoreThe Love Song of J Alfred Prufrock1966 Words   |  8 Pagessymbolism to capture the readers attention in The Love Song of J. Alfred Prufrock. The poem has a dramatic discourse. The percipience of lifes emptiness is the main theme of the poem. Eliot exhorts the spiritual decomposition by exploring a type of life in death. T. S. Eliot, who in the Clark Lectures notes, Real Irony is an expression of suffering(Lobb, 53), uses irony and symbolism throughout the poem to exemplify the suffering of J. Alfred Prufrock who believes he is filled with spiritual morbidityRead MoreThe Love Song Of J. Alfred Prufrock1005 Words   |  5 Pagesâ€Å"The Love Song of J. Alfred Prufrock,† published in 1915, was written by a man named T.S. Eliot. The speaker of the poem begins to describe an evening that appears to be somewhat romantic and a little mysterious. As the reader progresses into the poem, the mood soon fades and the reader starts to figure out that this evening is not what they pictured. â€Å"Acquainted with the Night† is a poem written by Robert Frost. The poem was first published in 1927. The speaker of the poem has a similar mood as

Financial Ratio Analysis

Question: Discuss the ratios and other calculations in the context of the companys profitability, efficiency, liquidity, gearing (leverage) and investment performance. Answer: Profitability Ratios Two of the most important measures of Billabongs profitability are return on assets and return on equity. Return on Assets Return on Assets (ROA) of Billabong will measure how effectively the company's assets are being used for generating its net profits. This useful measure provides Billabongs comparison with respect to its competitive performance. Formula This ratio is calculated by dividing net income by average total assets. Return on Equity Return on Equity (ROE) of Billabong will measure the net return per dollar which the common shareholders invested in the firm, (Baker Riddick, 2013). Formula This ratio is calculated by dividing net income by shareholder's equity. It should be noted that the profitability ratios are derived from the Billabongs income statement. Hence, these measures demonstrate the companys periodic performance, covering the period as reported in its income statement, (Taylor, 2013). Asset Utilization Ratios These ratios will provide the managements measure of control as the ratios provide guidance for critical factors concerned with the use of the Billabong's assets, inventory and collection of accounts receivable in the companys day-to-day operations, (Greuning, Scott Terblanche, 2011). Total Asset Turnover (TAT) The TAT demonstrates that Billabong has been using its assets productively over the year. Even though there is no substantial change in the value between 2014 and 2015 in the value of this ratio, such a situation also signifies that the management had an effective control over asset turnover, (Greuning, Scott Terblanche, 2011). Formula This ratio is calculated by dividing net sales by average total assets. Fixed Asset Turnover (FAT) Billabong has been making good use of its fixed assets, including its plant and equipment and has demonstrated that these are more aptly utilised for direct production along with the current assets, which include cash and accounts receivable, hence many analysts would be encouraged for recommending the company because of the companys this measure of effectiveness, (Keown et al, 2012). Formula This ratio is calculated by dividing net sales by average total fixed assets. Inventory Turnover Cost of goods sold (COGS) is derived from the companys income statement and it indicates those expenses which are attributed to production of the goods and which are sold during the specified period and inventory is a shown as a current asset on the balance sheet. The purpose of this measure is to see how often Billabong is utilising its inventory to further its sales during the specified period, (Keown et al, 2012). Formula This ratio is calculated by dividing the cost of goods sold for a specific period by the average inventory for the same period. Days Sales Outstanding (DSO) This is one critical ratio, also termed as Accounts Receivable Turnover ratio, which the management of Billabong must monitor on a regular basis. This ratio also reflects the average collection period of the company for its debts. A smaller DSO means that the management of Billabong has a tight control over its markets and is efficient in managing the funds of the shareholders, (Yona, 2011). Formula Accounts receivable turnover is calculated by dividing the net credit sales for a specific period by the average accounts receivable for that period. Leverage Ratios Leverage ratios provide measure of Billabong's use of debt financing. This is the reason why analysts use these extensively to arrive at decisions for recommending new credit or extension of an existing credit arrangement. Since the use of debt financing can increase the risk factor of the company, managements and creditors should monitor the additional risk constantly in connection with borrowing of money by the company and also take note of the increased opportunities which the fresh capital shall provide, (Yona, 2011). Total Debt Ratio The above discussion is important as any company has only two ways of financing the acquisition of an asset either through borrowed funds or by utilising funds generated from internal operations or by selling stock in the market. Billabongs debt ratio of 65% means that, for every dollar of assets which Billabong has, 65 cents are financed with debt finance, (Mudra, 2014). Formula This ratio is calculated by dividing total liabilities by total assets. Long-term Debt Ratio On the same basis as above, some creditors may also focus on Billabong's use of long-term debts. This can be determined as it incorporates a small variation in the total debt ratio, by incorporating long-term liabilities in the numerator. Debt-to-Equity Ratio The debt-to-equity ratio of 185% for Billabong means that for each dollar of itsequity, the company has 1.85 dollars of debt financing. The debt to equity ratio is a balance sheet ratio as all the elements are shown in the balance sheet, (Mudra, 2014). Formula This ratio is calculated by dividing total liabilities by total equity. Two other leverage ratios of Billabong are significant for the company's creditors and these are the times-interest-earned and the fixed-charge coverage ratios. These two ratios help the analysts in measuring the company's ability to meet its on-going commitments in servicing the debts which it had borrowed previously, (Taylor, 2013). Times Interest Earned The times-interest-earned (TIE) ratio in the case of Billabong has shown a decline from 5.62 in 2014 to 4.10 in 2015. But it is still a healthy indicator that the companys operating profits during the recent period also exceeded the total interest expenses by 410 percent. From the analysts point of view, the higher this ratio goes, the more will be Billabong considered to be strong financially, (Taylor, 2013). Formula This ratio is calculated by dividing income before interest and income taxes by the interest expense. Fixed Charge Coverage On the same basis as the time interest earned ratio, this fixed charge coverage ratio, which is also termed as the debt service coverage ratio, takes into account all the regular periodic obligations of the company for a given period. Formula This ratio starts with the times earned interest ratio and adds in applicable fixed costs. Liquidity Ratios The liquidity ratios are those measures which indicate the company's ability in repaying its short-term debt obligations. Current liabilities represent only those obligations which are required to be settled in one year or less, (Greuning, Scott Terblanche, 2011). Current Ratio This ratio compares the current assets held by Billabong in comparison to its current liabilities. Formula This ratio is calculated by dividing current assets by current liabilities. Quick ratio Analysts believe that the economic definition of liquidity for a company is its ability to turn an asset into cash at or near the fair market value of the asset. Since inventory cannot be easily sold, it is not considered to be able to meet any short-term obligations. By excluding inventories, this ratio gives a more stringent liquidity measure of the company as compared to the current ratio, (Greuning, Scott Terblanche, 2011). Formula This ratio is calculated by adding cash, cash equivalents, short-term investments, and current receivables together then dividing them by current liabilities. Market Value Ratios Investors and managements are interested in the market ratios, which can be used in valuing Billabong's common stock. Price/Earnings Ratio This ratio, which is universally known as the PE Ratio, has been the most widely-quoted statistical ratio which concerns a company's common stock, (Yona, 2011). Formula This ratio is calculated by dividing the market value price per share by theearnings per share. Market-to-book Ratio This ratio is another related measure, often used along with the PE Ratio, for stock valuation purposes by analysts. Most of the investors would like to compare Billabongs current price of the common stock with the companys book value of stock. Such a measure is termed as the price/book ratio. In case the ratio is greater than one and this is what happens to be the case for majority of stocks, then the analysts assume that the companys stock is trading at a premium as compared to its book value, (Baker Riddick, 2013). List Of References Baker, H.K. and Riddick, L.A. (2013) International Finance: A Survey. Oxford: OUP USA. Greuning, H., Scott, D. and Terblanche, S. (2011) International Financial Reporting Standards: A Practical Guide. Washington DC: World Bank Publications. Keown, A.J., Martin, J.D., Petty, J.W. and Scott, D.F. (2012) Financial Management: Principles and Applications (10th ed). New Delhi: Pearson Education India. Mudra, J. (2014) International Financial Management (12th ed). Stamford, CT: Cengage Learning. Taylor, M.P. (2013) Purchasing Power Parity and Real Exchange Rates. Oxon: Routledge Yona, L. (2011) International Finance for Developing Countries. Keynes: AuthorHouse.

Essential Nursing Care Chronic Obstructive Pulmonary Disease

Question: Discuss about the case study of Essential Nursing Care for Chronic Obstructive Pulmonary Disease. Answer: Introduction The assignment is a case study report on Luigi, an Italian man who is living in Australia since 40 years. He has worked as an accountant before his retirement. The purpose of this report is to identify the chronic ailment in patient and discuss the pathophysiology of the diagnosed illness in the patient. It will also give detail on the manifestation of each diagnosed illness in the patient. It will also give information about the complexities of the patient's condition. It will identify the interaction between patient's co-morbidities and how it can have an impact on the patient's family. Pathophysiology of disease The case study is on Luigi, a 77-year Italian man living in Australia. His health has declined over the years due to poorly controlled type 2 diabetes. He takes Metformin for controlling his diabetes. Although he is overweight, he does not pay attention to his diet and leads a sedentary lifestyle. His vision is blurring, and his ankles are swelling. He also has high blood pressure and protein in the urine. Further investigation revealed that he suffers from chronic renal failure. This section is a discussion of pathophysiology and clinical manifestation identified in the patient. Two significant chronic conditions diagnosed in the patient were type 2 diabetes and chronic renal failure. Type 2 diabetes is associated with the inability of the body to produce adequate insulin to meet the demands of the body. Patients with Type 2 diabetes develops insulin resistance where muscle and liver cells may fail to respond to insulin. It will result in an abnormal rise in the blood glucose level. The disease is also aggravated by obesity and physical activity (Scheen, 2014). So, Luigi's type 2 diabetes might have been poorly controlled because of his obesity and sedentary lifestyle. The dysfunction in the body is characterized by hyperglycemia resulting from inadequate insulin production and excessive glucagon secretion. Type 2 diabetes is asymptomatic, but clinical manifestations include polyuria, polyphagia, polydipsia, weight loss, and blurred vision and yeast infection. Luigi also had blurred vision due to type 2 diabetes. Type 2 diabetes occurs due to complex interaction of genetic and environmental factors. Therefore two primary defect pathophysiological abnormalities in type 2 diabetes are the -cell failure and insulin resistance (Kahn et al., 2014). The glucose regulation pathway is dependent on insulin secretion and insulin sensitivity. The progression of Type 2 diabetes occurs due to a continuous decline in -cell function. Insulin resistance in patients develops due to the elevated level of proinflammatory cytokines in plasma and fatty acids. Diabetes develops in those patients who cannot increase insulin secretion to balance insulin resistance. -cell dysfunction is a major factor in diabetes development, and it may develop in the early stage of the pathologic process. -cell fail to compensate insulin resistance. The -cell function is dependent on -cell mass and its secretory capacity. Therefore loss of -function might be due to lipotoxicity, insulin resistance and pre-existing genetically determined risk. Firstly, normal glucose tolerance proceeds to abnormal glucose tolerance. Then fasting hyperglycemia develops due to the failure of hepatic gluconeogenesis. Insulin resistance develops mainly due to obesity. The risk of diab etes is also high in patients with high plasma concentration of 3 amino acids (Meier Bonadonna, 2013). Luigi was finally diagnosed with chronic renal failure after urine and blood test. The symptoms are not visible until severe damage to the kidney. Common symptoms of chronic renal failure include increased urination at night, cloudy urine, edema (in hands and feet), high blood pressure, fatigue, shortness of breath and loss of appetite. Luigi also had high pressure and swelling in the leg which is a manifestation of chronic renal failure. Severe complications include anemia, hypertension, brittle bones, edema, the risk of bleeding and seizures. Luigi might have developed renal failure due to his poorly controlled Type 2 diabetes. Poor control of glucose gradually damages the function of kidneys. High blood pressure is also a leading cause of damage to the kidney (Popolo et al., 2013). IgA nephropathy is a cause for end-stage renal failure. Diabetes and high blood pressure destroy the small blood vessels in the body. Pathologic features of renal failure are fibrosis, loss of renal cel ls and infiltration of renal tissue by monocytes and macrophages. Proteinuria, hypoxia, and Angiotensin II production all lead to kidney failure. Angiotensin II is responsible for glomerular hypertension thereby damaging the kidney (Levey Coresh, 2012). The predisposing factors of the chronic condition are aging, congenital kidney defect, family history of renal failure, an autoimmune disorder. Precipitating factors like exposure to a toxin and particular medication, sedentary lightly and high residue diet is also responsible for manifestations of the disease condition (Gansevoort et al., 2013). Discussion on chronicity and complexity of condition Patient with diabetes is at increased risk of comorbidities like hypertension due to change in cardiac structure, nonalcoholic fatty liver disease and dyslipidemia. Patients like Luigi who have poor diabetic control may develop the risk of vascular complications. Diabetic control is poor in adolescent in spite of active follow up treatment. The progression of the disease is faster in obese children mainly due to the accumulation of lipids visceral compartment resulting in insulin resistance and reduced sensitivity of -cell. Several studies on patients with comorbid conditions like depression and type 2 Diabetes have also shown that mortality in such patient is high compared to a patient with diabetes alone (Luijks et al., 2012). As Luigi was finally diagnosed with chronic renal failure too, it has made his condition more complex and chronic. The common comorbidities associated chronic kidney disease are cardiovascular disease, anemia, malnutrition, depression, bone disorder and decreased functional status. Patients like Luigi are at more risk of dying due to the cardiovascular disease-related condition. Blood pressure control and glucose control is a vital factor in managing the comorbidities. However Luigi's blood pressure was also high and his diabetes was also poorly controlled. So, his condition was extremely complex in which immediate medical attention was necessary. It is also needed for Luigi to maintain his diet, increase physical activity and pharmacologic therapy. These activities will help him in controlling low-density lipoprotein cholesterol which is important to prevent cardiac disorder. Several patients with chronic renal failure develop anemia due to the improper synthesis of erythropoietin b y kidneys (Albrecht et al., 2016). Interaction of comorbidities Type 2 diabetes is a chronic illness for which continued medical attention and knowledge about preventing acute complication is necessary to minimize lifetime risk. Most patients with chronic kidney disease have been found to have one or more comorbidities that interact with each other. The first and second most significant conditions that have to lead to chronic renal failure in patients are diabetes and high blood pressure respectively. Luigi also had poorly controlled type 2 diabetes and high blood pressure. These conditions were also responsible for his renal failure. Patients with type 2 diabetes are at more risk of cardiovascular morbidity and mortality than patients without diabetes. These risk further augmented by other factors like hypertension, dyslipidemia, and obesity in patients. This also suggests that it is critical for Luigi to maintain his weight and reduce obesity (Look AHEAD Research Group. 2013). It is evident that patients like Luigi with comorbidities often take multiple medicines. Therefore Luigi will have to manage his medications properly and do regular health check-ups because his poorly controlled diabetes was only the reason for his chronic renal failure. High blood sugar level can damage many parts of the body. In type 2 diabetes, pancreas synthesizes insulin, but the body is unable to use it properly . Due to diabetes, small blood vessels get damaged. Due to this, the kidney cannot clean blood purify blood properly. It leads to more retention of water and salt contributing to weight gain and ankle swelling. It becomes apparent now why Luigi was obese and had swollen foot. It also leads to more protein in the urine ( Similar condition also found in Luigi). Diabetes also damages nerves in the body which has an effect on the function of the bladder. When the bladder is not emptied, pressure resulting from full bladder injures the kidney. This explains the reason why a patient with type 2 diabetes is at more risk of developing kidney disease (Perkovic et al., 2013). This section will discuss the relation between diabetes and cardiovascular system. Blood is an essential part of the cardiovascular system whereas diabetes is a condition in which level of blood glucose rises. So, it is evident that there must be some link between the two. Diabetes and cardiovascular system disease are related to each other due to insulin resistance syndrome. The National Diabetes Surveillance system report also revealed that among 20 million people with diabetes in U.S., 5-6 million of them have the cardiovascular disease too. The commonly diagnoses cardiovascular disease included stroke, high blood pressure, and coronary heart disease (Look AHEAD Research Group. 2013). Now based on the interaction of two ways by which comorbidities interact, it is necessary for such patients to manage treatment procedures properly. Luigi will have to follow suitable diet according to doctors advice. It will be necessary for him to have an open dialogue about his health with the physicians (Dunkler et al., 2013). Several modifications in risk factor will help Luigi to maintain health despite comorbidities. He will have to maintain his blood pressure and keep the BMI less than 27 to control his overall health condition. For proper maintenance of health, he will also have to do an annual urine test; retinal dilation test and biannual foot examination for sensation testing and pressure check (Copeland et al., 2013). A regular visit to the doctor should be his priority so that his improvement can be tracked by the doctor. Proper medication and advice from doctors will help Luigi in the long run. Lifestyle changes like increasing physical activity will be a crucial facto r in managing his diabetes. His treatment plan will include multiple drug therapy to reduce all the risk factors. Different types of insulin shots are available, and physician will help Luigi in choosing the best type for him. Since Luigi as developed renal failure, he will require a higher dose of insulin. Oral diabetes medication will assist in lowering blood glucose (American Diabetes Association, 2013). Older adults with diabetes are at more risk of cardiovascular disease. Lipid and blood pressure control will be an essential factor in reducing the risk of cardiovascular disease in Luigi. It will also depend on his overall health and frailty. Comprehensive education in self-management will also be necessary for him. The major component for self-management in Luigi will include self-monitoring of blood glucose, medical nutrition therapy, doing exercise regularly, Physiologically dependent insulin regimens or oral medications and periodic assessment of treatment goals. Metformin is also a common medicine prescribed to diabetes patients which Luigi was also taking (Inzucchi et al., 2014). It improves the sensitivity of body tissues to insulin and lowers glucose production in the urine. Other medications include Sulfonylureas, Meglitinides, Thiazolidinediones, DPP-4 inhibitors, etc. will also stimulate pancreas to secrete more insulin. Luigi will also need to do regular exercise like ae robics for 30 minutes every day. Stretching and strength training will also be beneficial for him. Luigi should take low glycemic index food after consultation with a registered dietitian that will fit his health goals (Kohan et al., 2014). The chronicity will also have an impact on Luigis family member. Family members also live with the disease and has to manage their disease. It is necessary for family members to support them and take care of their diet. A patient who involves their families can share their emotional concern with them, and they are less risk of stress. Emotional support by family members also has an effect on adherence to treatment regimen. Diagnosis of diabetes contributes to anxiety for family members as the comorbidities are difficult to manage initially (Mayberry Osborn, 2012). However, once family members are aware of the condition, they will be able to make lives better for their closed one by making them adhere to treatment regimen. Conclusion The case study report has summarized the chronic condition of Luigi. It identified the major disease that the patient was suffering from and gave detail about the pathophysiology and clinical manifestation of each diagnosed illness. It has explained the chronicity and complexity of patients condition. It identified two possible interactions of comorbidities and gave detail about the impact of these comorbidities on patients and family members. It provided detail about the possible treatment and medications required in such patients. Once the patient has knowledge about ways of managing their clinical condition, they can improve their health after following a treatment regimen. Reference Albrecht, J. S., Park, Y., Hur, P., Huang, T. Y., Harris, I., Netzer, G., ... Moyo, P. (2016). Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease: The Role of Depression.Annals of the American Thoracic Society, (ja). American Diabetes Association. (2013). Standards of medical care for patients with diabetes mellitus.Puerto Rico Health Sciences Journal,20(2). Copeland, K. C., Silverstein, J., Moore, K. R., Prazar, G. E., Raymer, T., Shiffman, R. N., ... Flinn, S. K. (2013). Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents.Pediatrics,131(2), 364-382. Dunkler, D., Dehghan, M., Teo, K. K., Heinze, G., Gao, P., Kohl, M., ... Oberbauer, R. (2013). Diet and kidney disease in high-risk individuals with type 2 diabetes mellitus.JAMA internal medicine,173(18), 1682-1692. Gansevoort, R. T., Correa-Rotter, R., Hemmelgarn, B. R., Jafar, T. H., Heerspink, H. J. L., Mann, J. F., ... Wen, C. P. (2013). Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention.The Lancet,382(9889), 339-352. Inzucchi, S. E., Lipska, K. J., Mayo, H., Bailey, C. J., McGuire, D. K. (2014). Metformin in patients with type 2 diabetes and kidney disease: a systematic review.Jama,312(24), 2668-2675. Kahn, S. E., Cooper, M. E., Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future.The Lancet,383(9922), 1068-1083. Kohan, D. E., Fioretto, P., Tang, W., List, J. F. (2014). Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control.Kidney international,85(4), 962-971. Levey, A. S., Coresh, J. (2012). Chronic kidney disease.The Lancet,379(9811), 165-180. Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.N engl J med,2013(369), 145-154. Luijks, H., Schermer, T., Bor, H., van Weel, C., Lagro-Janssen, T., Biermans, M., de Grauw, W. (2012). Prevalence and incidence density rates of chronic comorbidity in type 2 diabetes patients: an exploratory cohort study.BMC medicine,10(1), 1. Mayberry, L. S., Osborn, C. Y. (2012). Family support, medication adherence, and glycemic control among adults with type 2 diabetes.Diabetes care,35(6), 1239-1245. Meier, J. J., Bonadonna, R. C. (2013). Role of reduced -cell mass versus impaired -cell function in the pathogenesis of type 2 diabetes.Diabetes care,36(Supplement 2), S113-S119. Perkovic, V., Heerspink, H. L., Chalmers, J., Woodward, M., Jun, M., Li, Q., Mogensen, C. E. (2013). Intensive glucose control improves kidney outcomes in patients with type 2 diabetes.Kidney international,83(3), 517-523. Popolo, A., Autore, G., Pinto, A., Marzocco, S. (2013). Oxidative stress in patients with cardiovascular disease and chronic renal failure.Free radical research,47(5), 346-356. Scheen, A. J. (2014). Pathophysiology of type 2 diabetes.Acta Clinica Belgica.