Thursday, February 28, 2019
Executive Summary Welcome to the future of melody pastime for your next accompaniment. Kari and the Keys, brings to the community of Cedar Rapids and surrounding atomic number 18as, a breath of good air in melody delight. By combining 2 indue harmonyians, going the extra mile, and crack cocaineing a full variety of music styles to suit your needs, Kari and the Keys pass on lead the event recreation grocery storeplace, providing a appraise worthy performance every time.Kari and the Keys is a sm both ancestry aimed at the big time. In baffle to r for each 1 our giant goals, we must(prenominal) emphasis on the burster behind the vision. We offer a one-deuce punch by providing a singer and accompanist, provide a superior sound system, and regard a worry and hassle-free event all with one phone call. c be In tune with the needs of the market, consis cristaltly updating our music portfolio, all while ensuring the guest receives the individual attention they dese rve, is the vision and daily mission of Kari and the Keys. 2.Objective It is our objective to Achieve name recognition labeled as the trounce entertainment for your event Provide the convenience of a one substantiation shop for music entertainment offering better talent ND prices than our competitors delivering top notch customer satisfaction. Obtain 30% of the market distribute for event entertainers inwardly 2 geezerhood 3. Mission Inspired by our passion for music, Kari and the Keys want to engage your audience In an Incredible music experience, through a praise-worthy performance, for your event. 4. Keys to success Our keys to success allow in a.Offering Talented Musicians professionally trained role players who launch of ground a passion for music and perfor minuteg Eric Sternest electric organist/Plants, formally studied music and Plano at Amanita State university, 25 years of experience. Karl Burch Singer (Soprano/Alto), formally studied music and vocal performanc e at university of Iowa, 20 years of experience b. Customer Satisfaction We strive for typic focus on the customers satisfaction and his/her experience both with us and the termination received by hiring for an event. 5.Company Summary Kari and the Keys is comprised of a singer (Kari Burch) and an accompanist (Eric Sternest) balmy/organ, fully equipped to perform at your personal or corporate event. We are both formally trained musicians and offer a wide variety of music to choose from for your special event including Recent step to the fore songs, Music from the asss and asss, Traditional/non-traditional espousal and/or secular music, Popular/traditional Christmas music. Additionally, we own a professional sound system inclusive of two (2) main speakers, monitor, mixer, microphone and keyboard.Our primary focus of business will be weddings and corporate events however, we gift the cap faculty to provide music entertainment for most occasions. The geographic area we are focu sing on for trade and go is primarily locations within the Cedar Rapids Metro Area (inclusive of Cedar Rapids, Marion and Hiawatha). It is all great(p) that all business conducted will accommodate an issuing Contract, which is a legitimately binding agreement betwixt Kari and the Keys and the Event Requester. A down defrayment of $150 is required to hold the date for each event.This is a non- refundable payment and required at the time the event date is booked and Event Contract executed. Kari and the Keys is organized as a partnership encompassing two general partners who are Kari J. Burch and Eric Sternest each owns 50% of the company. Kari conducts the accounting, merchandise strategies and legal duties Eric handles instruction execution on social media, the companys website design, and booking requests. Each partner shares daily business duties evenly. 6. Company History Eric and I have known of each opposite for 20 years. Even then we both recognize and appreciated each other for our respective musical talents.Ab out 2 years ago, I reached out to Eric to determine whether or not he would be interested in playing for me with the invention to record a few traditional and non-traditional wedding songs. I was aspect for an outlet to be able to get hold up into the singing world. Time went by and schedules precluded things from formulating. In January 2014, we reconnected and decided that we no yearner wanted to squander our musical talent. With the passion for music and the uncanny ability to perform seamlessly as a duo, we decided to form Kari and the Keys. The initial intention was Daniel Urethras, Parlor City, Java Creek, etc.However, after investigating the local event entertainment market, we believed our team could offer an avenue of refinement and amazing live entertainment for both weddings and corporate events. Kari and the Keys are able to offer a one stop shop when a person or organization is looking to book music for an event. The customer isnt burdened with finding and coordinating a singer and a diffused player we offer both. We are a talented team who has the ability to discoveren, understand and respond uniquely and creatively to the growing needs and constantly fluid give birthations of our customers.Additionally, based on our research, Kari and the Keys is the scarce singer/piano duos in the Cedar Rapids Metro Area. 7. Products and Service Kari and the Keys are event entertainers. We are comprised of a female singer and male piano player by trade and offer a variety of music genres to provide either focal r background entertainment at your special event. Additionally, we are not pretentious performers who demand or expect things from our customers. We believe our strength lies in working for and satisfying every customer.In order to achieve the expectations of the customer, we believe in key service quality ideals, which will help us attain a high level of customer satisfaction. Such ideals includ e I. Timeliness and convenience it. Personal attention to suited needs and wants iii. Reliable and dependable v. Responsiveness to requests v. Assurances and availability We in any case share a common rally for success. We dont simply want to be a run of the mill performance act we want to be the recognized leader if you are looking for music to be performed at your event.Kari and the Keys have established the by-line fee structure, based on a special(prenominal) event Booking Fee to hold the date- $1 50 (non-refundable) wedding Package $500 which includes Wedding rehearsal at location (30 min) Organ/Piano Processional and Recessional, Pre and Post Wedding music (as background) 15 min each Vocalist/Accompaniment two (2) song chosen from selected list Songs are chosen from selected list Open bar and food shall be provided Set up/tear down 2 mins of music, 2 ten minute breaks w/in 2 hours Approximately 10 songs per hour Songs are chosen from selected list Music outside of selected list $75 per song 8. commercialise Analysis Summary a. Size of grocery store (State & County Kickbacks), (Marion, Iowa), (Hiawatha, Iowa), (Cedar Rapids, Iowa) I. Population Demographics Estimated race of Cedar Rapids Metro Area (inclusive of Cedar Rapids, Marion and Hiawatha) is approve. KICK (Cedar Rapids KICK, Marion ASK, Hiawatha K) Median income of males $41 K/year Median income of females $ASK/year 27% of the nation is 25 to 44 t. stir Recognized Employers Rockwell Collins (8,700) Transcends/AEGEAN (3,900) SST.Lukewarmly pull down (3,200) Cedar Rapids Community School District (3,000) WHY-eve (2,600) Mercy Medical come to (2,300) Whirlpool (2,500) Kirkwood Community College (1 ,900) City of Cedar Rapids (1,400) Quaker toecaps (1 Other companies include Archer Daniel Midland (DAM), Cargill, General Mills, Toyota Financial and Nordstrom b. Competitors I. To research our competition we utilize both internet websites which advertise for hire for musicians (sear ch Wedding, Corporate Events and music groups) and also utilized the SABA tool called Size It Up (searched Entertainment Weddings, Party, and Corporate Events). T. In targeting the Cedar Rapids Metro Area (inclusive of Cedar Rapids, Marion and Hiawatha) our direct competition would include state from the following categories which represented a total of 31 event entertainers 1. Vocalists 2. Accompanists (Piano/Organ/Guitar) 3. Comedy Acts 4. DC ill. We understand that this represents yet a crushed segment of the true number of musicians located in the Metro Area. However, playscript of mouth would be the best Word of mouth is very important in this category of business and it is crucial to the success of any music ensemble.However, we believe going after the market with a guerrilla marketing campaign, becoming visible in the music community and establishing a following will help us to capture the event entertainment market. C. Market Growth/Trends There is a constant flux of yo ung musicians within the Cedar Rapids Metro Area. People consistently believe that they will be the next American idol pop sensation and will be discovered in this market. The reality of the situation is the saturation with UN-trained, low skill musicians, trying to make a buck. Because of this, Kari and the Keys are able to capitalize on our talent, skill and upscale performance.We are organized, marketable and ready to succeed. 9. Target Market We define our initial target market as such Females and males predominately between the ages of 25 45, non-married with a combined income of $ASK or more per year. Name recognized businesses Cedar Rapids Metro Area (inclusive of Cedar Rapids, Marion and Hiawatha) 10. How do we eviscerate our Target Market? A. Establish an on-line presence b. Establish a word of mouth campaign based on our stellar performances at local ensues such as turn out mice nights, restaurant/ nix, and coffee houses c.As performances are booked, wad view Online Calendar Lists This week at Ramsets d. Direct posting to local organizations Churches Wedding Dress Boutiques Wedding Planners Country Clubs Restaurant/bars Coffee Shops West Music 11. Industry Analysis a. The threat of new entrants is in an amplified state of flux. Because of the Reality Televisions shows such as American Idol and the Voice, the increasing number of people thinking they are musicians has intensified the popularity of open mice night ensues to display their talents.However, the thought and desire to be a star, does not mean they are talented enough to make it as an entertainer. The market at an alarming rate. However, this is not a substitute for musicians who have the talent, drive and the means to wage a successful campaign to gain the market share in a given location. C. The bargaining agent of customers is super critical in a musicians world. Since the market is saturated, everyone is fighting for a piece of the pie to be recognized in a public venue as some one who is horrible.Because of this saturation, musicians ability to be paid for performance is directly tally with the amount of potential business a musician can draw. If the musician is relatively unknown in the market, the establishment can hire you for cheap. This is wherefore it is crucial to participate in any public venue to commence to establish a core group of followers or people willing to spend money while watching you perform. Once people begin a word of mouth campaign on your behalf, only then will you have leverage to negotiate with customers. D. The bargaining power of suppliers is relatively low.Anyone with a guitar, acrophobic and an amp can be a musician. Whether or not they are successful is not dependent on a supplier. E. Again, the competition for musician event entertainment is high. It is imperative to be able to set yourself a part of the competition. A musician must pay their dues by performing, be more talented than the next guy, offer something that no one else does, build a following, utilize guerrilla marketing techniques to keep your name at the front and be proactive in gaining market share. 12. Online Plan Summary a. Obtain a Website Domain grandfathering. Com b. figure a professional website
This chapter discuss slightly the The Student Council elections have always been a perennial activity for every develop. It is an activity wherein each student is required to choose from a pot of candidates who will represent each position in the Student Council. In coiffe for the student to accomplish this, the student must go through several processes. First the student must go to the Administration part if he is a registered voter, wherefore goes to the voting area and chooses the candidates he likes. subsequently that, the student submits the filled-up ballot form to the voting administrator in order for his votes to be cast. Then the student is marked with an indelible ink to designate that he has already voted. After all the votes have been cast, the voting social occasion goes again through several processes. The votes are collected and are then counted, which could take several hours to several days, depending on the volume of votes. Background of the exact The chap ter discuss computers greatly enhance the speed and efficiency of voting process.Results could be attained even right after the elections reducing the time to a mere fraction compared to the time it takes if the voting is done manually. It also increases the train of the voting experience because of multimedia enhancements. The present generation, people became more literate especially with the use of computers. Technologies emerged to introduce many different ways of advancement. calculator machines are of these. Computers now in existence are the most omnipotent machines than can do anything peoples lives.It is in this effect that the counsel has decided to propose a system to improve the existing manual voting system. The proponent aims to convert the existing manual system into an machine-driven voting system. Information Technology Elections are held in every school year for the BSIT students of Arellano University-Pasig. Where the positions are President, Vice- President s, Secretary, Treasurer, Auditor, P. I. O, and First year to Fourth year Representative. employ computers would make the election faster. With the new system, votes are tallied and transmitted electronically.
Wednesday, February 27, 2019
There atomic number 18 universally acclaimed structures of partnership and these can either be beneficial for the individuals or not. One of the many political doctrines that can be beneficial to the individuals of a society is Egalitarianism. Egalitarian is referred to be as a soft of society which gives equal rights and opportunities to the people. Egalitarian societies give equal treatments to their people, equal rights to resources, equal in moral status and equal rights of the laws and church and they dont subscribe even permanent leadership.The notion of egalitarianism came about because in scriptural verses, it was written that God loved His people equally (Arneson). Another kind of political doctrine is the kindly stratification it is viewed as the social hierarchy of social classes and strata within a society. Social stratification is universally acclaimed plainly varies accordingly to the societies that uphold it.There atomic number 18 three major components of soc ial stratification according to the conflict-perspective sociologist Max Weber the class, status and party. The status of a person in the society plays a big role in the determination of his or her role and his behavioral patterns and changes that he or she bequeath have. There are actually four classes in a tell society the propertied class, the property less class, the bourgeoisie, and the working class.An individuals role in a society is predicted by the class he or she is under. In stratified societies, those who have the capital are the ones who dominate and have the greater opportunity to the resources and services and those who have nothing are have the lesser opportunity (Rodriguez). Societies have differences some give equal rights to the people and others do not. Thus, societies continue to exist because social order is maintained.
IBM leading the engine room diligence passed through several challenges in last few decades. IBM had infragone substantive changes to encounter authorisation of its business. Market competition and globalization of labor decreased the effectiveness of IBM requiring change in structure and work place setting. IBM focused on its outcome repugnncies while success richly adopted new managerial structure placing tenseness on flexible last making with cast upd responsibility on first line managers. Case Statement IBM was successfully leading the technology industry since its formation and profitably cut acrossd in various commercialises globally.However, the go with expand incautiously resulting in increased overhead cost although profits were rise but gradual change in demand by the devastation of year 1990 create significant monetary problems for company depicted in huge losses for the consecutive three years. This case identifies the reasons which root to IBM limit i n 1990 and sequential pattern of changes in structure which touched the financial performance of company. This case classifies the role of management in IBM performance and associated allude of overhead on company potential to grow.Basically, this case categorizes the problems which plunged the IBM to move towards trouble and associated role of management. Situation Analysis of IBM under John Akers Leadership IBM was unconditional approx. 70% profits of global technology industry in eighties beginning era. However, during the last years of decade company was encountered with serious problems that affected the performance of company. John Akers, CEO of IBM appointed in year 1985, created significant changes in brass instrument structure and work settings defined new setting of decision making and operational procedures conforming his attitude and behavior.Company renders on assets and on equity started eroding and finally move towards negative rejoin on business. IBM suffered w ith decreasing market share, loss of profits, negative perception create of clients towards IBM, increasing competition, and failures in product launch (Hitt et al. , 2007). IBM was striving hard to compete with new entrants in market, maintain its profitability level, and kept high market demand for its mainframe data processors. Company was following bureaucratic structure, centralized decision making hindering to the growth of company.IBM overhead costs were momentous to industry average cost overhead costs were three times of industry, company was offering high perks and benefits to employees, majority of employees were detrimental to work requirement, executives were not fully productive and were relying on junior members to perform their duties (creating unnecessary employment). Company had one hundred twenty-five data centers globally internally organization was not proficient in IT management resulting in bad performance of IBM.Research department of IBM appeared otios e to design products in consideration of customer demand which created significant problems in the beginning of 1991 (Hitt et al. , 2007), pushing company towards change in management structure, and requiring mountainous scale operational change in organization to cover up its cost from current demand level. SWOT Analysis of IBM IBM is operating globally leading the industry with its unmatched solution compare to competitors offerings remarking the business performance. A brief SWOT analysis of IBM is as underStrengths IBM offers a range of solutions to numerous businesses which polariated it from competitors. IBM was dealing in mainframes, mainframe storage, single user personal computers, minicomputers, and client/server solutions. Company was towering high profits from the industry, therefore spending high amount on R&D to invent and design products in consideration of future tense demand (Hitt et al. , 2007). IBM has strong brand image which increases the company sustainabil ity and efficiently penetrate in competitive markets.Company had effective teams of personnel reach to customers was worthful due to high value propositions. Weaknesses IBM was following bureaucratic structure and ranking(prenominal) executives were running the operational decisions limited decision making power cut down the innovation and hindered the growth of company. Company had employed unnecessary people to attain job tasks, increasing the cost. However, senior management members were relying on junior/ concord members for reporting purposes which resulted in refined information flow necessary for organization function irrespective of challenges that can be faced in enormous run.Executives remuneration was very high compare to services in return to organization overhead costs dramatically increase as different competitors entered in industry (Hickman, 2006). IBM did not focus on offering of web browser and network integration application which revolutionized the industry i n early nineties however investing in OS/2 operating strategy resulted in financial losses. Opportunities IBM being one of the giant leaders of technology industry secures high profits and market share. This provides company an opportunity to elapse small business entities to offer diverse and complete range of products to customer (one stop solution).Competitors were investing huge amount on new products earthly concern which IBM can use in its product portfolio to reach global consumers to increase brand value. Threats New competitors which include DELL, ACCENTURE, COMPAQ and MICROSOFT focused on offering computer products at cheap prices (Hitt et al. , 2007) IBM rely on Intel for some of its core corporeal component supply IBM customer relationship management strategy inefficiency of R&D to design innovative solution market globalization and organization structure created direct threats to IBM market share.
Tuesday, February 26, 2019
The steer of this assignment is to citically examine the medical toughie in congenator to a client that I am acting with, for reasons of confidentiality I stomach utilize a pseudo name The medical perspectives in amiable Health. screen background Alan is a 42 yr old unobjectionable british male, he was diagnosed with schitzophrenia at the age of 21yrs. He is the eldest of twain children, his sister re offices with her keep up and children nearby. Alan resides at home with his pargonnts, who be in their early seventies. Alan has always complied with music, and agree to infirmaryization when necessary, compulsory ad young womanion has non been required. Scitzophrenia is a devastating psychical untowardneess, and probably the most distressing and disabling of the severe amiable disorders. The start signs of schizophrenia typically emerge in adolescence or young adult. The effect of the illness atomic number 18 conf exploitation and oft shocking to families and fri ends. http//www. psychia effort24x7. com. schizophrenia retreived 19/01/06. Alan is seen by his shrink, every six months, unless he is unwell, when he allow be seen some(prenominal) than frequently. He is reviewed through the guard program speak to at hospital out- patients.His key worker is a community psychiatric nurse, (CPN). The psychiatrist plays a central section in the diagnosis of a psychogenic disorder. Diagnosis is made afterwards a mental wellness examination. The role of the psychiatrist in the mental state examination serves two purposes A detailed history is taken to identify change and characteristic clusters suggestive of a detail psychiatric disorder. Secondly the psychiatrist has to make a comparison of change against a diagnostic criteria to establish presence or non of a specific psychiatric disorder. (Holland, 2003, p. 938) After illiminating organic cause, by physical examination, the psychiatrist makes a diagnosis by classification of the sy mptoms. In to age psychopathology there are two systems utilize to more faithfully identify a mental disorder. The International Classification of Disease, 10th revision, (ICD10), and the American Classification Diagnostic and Statistical Manual, 4th revision, (DSMIV). European mental medicine are guided by the former. The ICD10 catogarises schizophrenia beneath, F. 20. using the description of Kurt Schieders eldest rank symptoms, (1959).These are ranked as A D, an early(a)(prenominal) symptoms E-I realise also been added. (p. 49, ICD10, WHO 1992,). For a diagnosis of Schitzophrenia the psyche must show at to the lowest degree unitary of the first rank symptoms A- D and at least two of the symptoms, E- I. Alan experiences Thought withdrawal, insertion and broadcasting, he beleives that both(prenominal)one or something is prudent for this. (First Rank symptom A). Auditory Hallucinations, he hears a running comment about him. (First Rank symptom C). These are also kn own as the positive symptoms of schitzophrenia.Alan also experiences more than two of the symptoms E I, he has panorama disorder, anxiety,depression and poor motivation, referred to as negative symptoms. (Kingdom, cited Bailey, 2000) The ICD10, goes on to provide subsections for types of schizophrena, and nones not everyone agrees with the sub-sections, collectible to the everywherelapping symptoms that can be present from one type to another. tally to Alans medical notes and on a uncaseg him, he does not seem to be possessed of been diagnosed with a specific type of schizophrenia. Given the clusters of symptoms that e has experienced, at heterogeneous times, it would be difficult to place Alan into one of the sub- sections. The medical model excepts that the schizoprenic brain has increased ventricles, (spaces in the brain), which leads to an imbalance of chemicals in the brain. Using their primary(prenominal) tool pshycopharmoglogy, they prescribe drugs to correct this im balance. (Leonard,2003). The pathology of the illness considers that the chemical which is imbalanced is dopamine. Drugs used to strain mental disorders are known as neoroleptics or psychotropics, they point the chemical dopamine by blocking the neuroreceptors.The drugs effect behaviour, psychological cognitive function and/or the sensory experience. They also effect other neurotransmitters in the brain, such(prenominal) as serotonan, a chemical associated with affective disorders, therefore, the analogous drugs are used to dainty different diagnosises. (Barry,2002). Alan has been prescribed various psychotropic drugs to try and control the positive and negative symptoms of schizophrenia. His medical notes stage that drugs begin been introduced, lessen and increased on a number of occassions, with little effect of relieving the symptoms substancially over a long period of time.Over the years in psychiatry drugs hurt evolved, Alan has been prescribed some of the older drugs , Chlorpromazine and Haloperidol, these are referred to as typicaldrugs. These drugs cause side- effect such as pseudoparkinsonism, (uncontrolable shaking of limbs), and Akathisia, (an uncomfortable congenital restlessness and anxiety). (Barry 2002). Further music was prescribed to combat these side- effects. Following this Alans psychiatrist changed his medication to the newer atypicaldrugs olanzipane and risperidone.Alan did not respond to this medication and after a deteration in his mental health he was admitted to hospital and agree to try another atypical drugclozaril thearapy. Given the toxicity of clozaril it is not used as freely as other psychtropic medication. A complication of clozaril is the effect that it has on the white telephone circuit cells, if the deficiency be get downs to great the drug can kill. (Barry 2002). To reduce the possibility of this the white cells are monitered through regular blood testing.The outcome of the long call effect of these drugs is not yet fully known. (Barry, 2002). Psychiatry does not go without critisim, Szass, (1997), best known as an anti psychiatrist, challenges the concept of mental health as an illness. For an illness to be an illness it has to be classified as having three commonalities, cause progression and outcome. He argues that schizophrenia does not piece of ground any commonality, and that the reason a scitzophrenic patient becomes a patient is because those round him refuses to except a behaviour beyond the norm.Laing, (1985), also supports this theory and informs the indorser that psychiatry is the only medical model that does not have an submit pathology that is proven by labortory testing. Another school of thought suggests individuals are hardened for the side-effects of medication moreso than the original illness, (Illich, cited in Laing 1985). They can end up battle side effects One drug to combat another. Prehaps it is the medication that ends up disturbing mental behaviour, wa rping personalities or or conditions in to bigger problems. ( Hewitt, 2001, p. 72) Alan prosponed the decision to take clorazil due to the risk of toxicity. Since commencing interposition, the symptoms have rock-bottom but not deminished, he still takes medication for side-effects, anxiety and depression. He continues to struggle with daily living. His anxiety levels are so intense, that this condition has preceeded the effects of schizophrenia, which has led to further isolation from community, he would like to engage in employment, paid or unpaid, however in his current frame of thinker this is not a possibility.Labour force 1995, reported that employment figures in mental health patients are much lower than any other disabled group. Only 21% of mountain with mental health problems are working or actively seeking work. (Webb&Tossell, 1999). Warnings on some medication advise that machinery must not be used, vechiles must not be driven, due to side-effects of drowsiness, alcoh ol should not be taken with a luck of psyhcotropic medication. All of these restrictions bushel upon Alans ability to function in society. Secondry to this, Alan has to distribute with the stigma attached to mental health disorders.There is a stereophony typical fond perception that individuals with mental health subject fields are more dangerous than others, regardless of research suggesting the opposite Philo et al, (1993), published research to demonstrate that there is no separate to suggest that a person with mental health issues is any more likely to harm than anyone else. Figures over the lead 20 yrs demonstrate that there has been no increase in slaughter caused by someone with mental health problems,whilst the increase amongt the general polulation has more than doubled. Research shows that this discrimination within mental health does not full stop with the lay person.White, horse opera good deal have better experience of the supporter than other ethnic grou ps. (Haddad & knapp, 2000). The Sainsbury Cenre for noetic Health, (SCMH), (2002), in its aim to cultivate national policy high lighted the inequalities experinced by Black and African Carribean communities. SCMHs findings suggest that professional have a fear of some ethnic minority groups, due to individual size or skin colour. It is these stereotypical beliefs, cultural ignorance and racist views, that prejudice assessments and influences preaching, reponses therefore rely on heavy medication and restriction.The consequences of which can be dentrimental, and have resulted in death, for people like David Bennett. In response to high profile cases, the Governement have produced various documentation to address issues of inequality. Delivering hurry and Equality, (2003), set out to provide an act plan over 7yrs to improve mental health go for ethnic minority groups. The focus is on raising professional awarness around culture, ethnicity and racism. As the western world progres ses towards a multi-cultural society, it is inescapable that more people from ethinic minorities will come in contact with mental health services.Fernando, (1991), considers this to be of a special concern and warns that The white domination of black people promotes, and often imposes a cultural domination so that ways of thinking, family life patterns of mental health and mental health care that are identified as Europeanin tradition whiteby racial origin, are seen as superior to others. (p. 198) Fernando, goes on to highlight the fact that many forms of kind-hearted distress medicalised by western society are not medicalised by other societies, and notes that political forces dominates what is an illness and gives ultimate power to the psychiatry to treat. wherefore suggesting that individual diagnosis can regard upon where you reside in the world. Rack, (1982), notes that western psychiatry has an all important(predicate) role in affable control, whilst Asian psychiatry is l argely concerned with spiritual development. Fenando states medicine too is part of a culture and not a system with a life of its own outside the culture in which it lives. (P. 197) He advises that a reliable diagnosis is unlikely, unless the individual is interwiewed in their own language, as only a person with the same language knows what to look for.If Racks theory is correct then services have a lot to achieve to gain full equality. gibe to research it is not only the diagnosis in mental health that globally differs, it is also the recovery rate. Research under taken by WHO, (1938, 1958, 1988, 1998), evidenced that only 33% of individuals diagnosed with schizoprenia in western soceity were successfully do by by drugs. A further pilot study by the same organisation, in the recovery of schizophrenia demonstrated that recovery rates in London and Washington, (33%, 34%), were immensly lower than in IBADIAN AND MAGA PERDESH, (86%,87%).The variable out come appeared to be talking methods and a positve out look from the onset. People were discuss that they would get better rather than existence told there future would depend upon medication. Colman, (2004), suggests Most psychiatic doctors appear to be wedded to the idea that they must treat everyone with medication and that it is only through the use of medication that people recover. The evidence for ths view appears to be based on research carried out using moneys supplied by pharmacutical industry. (p. 4). Colmans view does not stand alone, Klass, (1975), advises that drug treatment is encouraged by the profit they make for their producers, who also provide the drugs to treat the side-effects. Large profits from the industry is used to provide research and labour what they view as successful intervention for mental disorders. (cited Pilgrim&Rogers, 1987). In relation to Alans drug therapy and the side-effects of anxiety, I have spoken to his treatment team regarding alternative therapy such as Anxiety Management.The response was that he had this previously and is unable to sustain self help techniques. My view was that this was a support issue, psychosocial therapy costs more than drug therapy. (Pilgrim&Rogers, 1987). It appears to come secondary to drug therapy in the view of the medical model. Whilst it is generally conceded by most commenters on psychiatry that it is now electic The bias towards physical treatment is still strong. (p. 121. Baruch&treacher,1978, Roman,1985, Bushfield 1986, cited Pilgrim&Rogers, 1987).Alan has spoke with me regarding the conscequences of taenia treatment to combat the side-effects. Pilgrim & Rogers, (1987), amongst others acknowledge that individuals may stop complying with medication if the side effects from the drugs become intolerable and they are not listened to. treating psychiatrists do not take their complaints about side-effects, or their concerns about the debilitating effects of the drugs, seriously. Instead, doctors slant to be c oncerned only with the effectiveness of the drugs in symptom reducing (assessed by them, not the patients themselves). p. 125 ) If Alan chose not to comply to medication, experienced a deteriation in his mental health and refused voluntary admission to hospital he could be detained under the Mental Health Act 1983. (MHA). The mental state examination would be under took by a doctor who was not exculded under s12 of the act (MHA1983,cited Jones, 2004). In good practise Alan should be assessed by his psychiatrist and his own general Practitioner. Thus meeting the requirements of s 12 2, (MHA1983). Both doctors must examine the patient within five days of each other (s12,1,MHA1983).As Alan is known to the clinical team, and has a specific diagnosis, admission for traetment (s3 MHA, 1983, cited Jones 2004), would possibly be the proposed section. (Code of Practise, 1999, ch5). Laing, (1985), Szass, (1997), claims that psychiatry is used to police society and not to treat the individual. Psychiatrists have been given the power to lock people up and treat them against their will, they have more power than a judge, and hospital wards provide a prison for the unconvicted individuals who do not meet societal norms.The approved social worker,(ASW), also has a powerful role under the 1983 Act and does make the ultimate decision as to whether treatment in hospital is the most appropriate form of treatment. (s132,MHA1983). As a social worker under taking the duty of an ASW, (albiet as a shadow), I have been faced with dilemas whereby the role and duty of an ASW conflict with my social work values, instead of promoting rights and autonomy I am restricting them. I am managing this by addressing the issues in debriefing following the ssessments, in supervision, and by challenging other professionals practise when necessary. For example, on one assessment, nursing staff had observed a patient as being withdrawn because he chose not to watch television in the communial lounge. During interview, the patient advised that he was a Johava witness and was oppossed to violence which was all that was on the particular channel viewed in the lounge. On addressing this with staff, it was clear that cultural or religous needs this had not been taken in to consideration.If Alan was formally admitted to hospital his psychiatrist does have the power to treat him against his wish. (part IV, MHA1983). This could include invasive treatment such as ECT, which Alan is oppossed to. I am therefore proposing Alan prepares an advanced directive, which will be incorporated in his careplan. Although, this does not over ride the clinical desicion his treatment team will need to take his views and wishes in to consideraton. MHA Alan is supported by his family they have a good insight in to his illness, his father has belatedly been diagnosed with Alziemens disease.My current concern is that his mother is a carer for two family members. The largest ratio of community care is carri ed out by unpaid family members, who often miss out on employment and become isloated. (Webb&Tossell, 1999). To ensure that Mrs A, is able to continue in her role, her needs also must be met. I have therefore requested an updated assessment under The Carers (recognition and service) Act 1995. Mrs. As wellbeing is paramount in preventing deteriation of the home situation which would inevitabley impact upon Alans mental health. Mrs.A sleep withs the signs and symptoms when Alans mental health starts to deteriate, which in cut into has historially prevented admission to hospital. Research from All Saints Hospital Birmingham evidenced that 59% of relatives recognise early warning signs one month before relapse and 75% two weeks before relapse. (cited Howe, 1998). Mrs. A feels that she is coping at present with the care of her support worker she is able to off load. She accesses carers groups which she finds helpful. If the situation becomes to much the family have agreed to access fu rther support for Mr. A. nder The Community Care and National Health Service Act 1990. Alan receives support from the day means where he is involved with Art therapy and other activities. He attends the Fountain club, (a intellect project), where he has access to support through group therapy, and attends respite two days a month. Alan finds these resourses useful in helping him to live with not only schizophrena but also the side-effects of his medication. He is offered support and advise that is not from a medical perspective. The family also consider that alternative therapy is as important to them, as to Alan. Mrs.A considers that Alan and the familys needs have been better met since a holistic approach has been under taken, as social and pshcological factors are adressed, aswell as the pathology of the illness. Howe, ( 1998), acknowleges that this has been a general failure in the medical model. I have not progressed with my original task regarding accomodation because I feel that Alan has enough overtaking on in his life at present, in coming to footing with his fathers illness. Although his CPN, considers that this would be in his best interest, the family do not want it and I am not convinced it is what Alan wants either.Szass, (1997), refers to how the mentally ill pateint is considered to be incompetant where as the medically ill pateint is considered to be competant. If Alan did not have a mental disorder, residing at home would not be an issue for anyone, other than the family. I will continue to project my view wtih the CPN and in supervision. In conclusion to this assignment I would agree that all those who work with in this area have far to go in create services. My role amongst this will be to challenge oppression, by raising awarness as I have done in practise, and to promote an holistic approach towards assessment.I am of the view that medication does help certian individuals, and their life has alter with medication. However in my view this should be minimal to releive distress and enhance with other socialogical and pyshcological intervention. Although relapse cannot be illiminated, research and literature referenced end-to-end this assignment suggests that there is a high colleration surrounded by staying well and receiving a combination of services. Drawing from my previous managerial experience I have know doubt that the constraints on budgets will effect resources, which will inevitable effect the services individauls receive.Pilgrim&Rogers, (1987), acknowledge that the limitation of resourses and the cost to them, which is not measured in comparison to physical treatment has been a factor that has prevented psychological and social models from competeing against the medical model. Undoubtabley this will need to change to allow individuals a successful chance of recovery. Authors referred to who opposs psychiatry and its role do have a fair arguement, in that drug treatment and legislation polices society , however no realistic alternative is provided.In my view the way forward is through raising public and professional awareness and de-stigmatising mental disorder. Word conceive 3297 References Barry, P. (2003). Mental Health and Mental Illness. (7th ed). Philidelphia.. Lippincott. Colman, R. (2004). Recovery an Alien Concept. (2nd Ed). Fife. P. P press. Delivering Race and Equality, (2003) The Sainsbury Centre for Mental Health, breaking the Circles of Fear, breifing 17. A review of the relationship between mental health services and African Caribbean communities. London. Fernando, S. (1991). Menatal Health Race and Culture.London. headway publications in association with Macmillon. Hewitt, P. (2001). So You Think Your Mad, 7 Practical stairs to Mental Health. Ppppppppppp Handsell Publishing. Howe, G. (1998). Getting in to the System, Living with Severe Mental Illness. London. Jessica Kingsley publishers Ltd. Jones, R. (2004). Mental Health Act Mannual. (9th Ed). London. Sweet &M axwell Ltd. Laing, R. D. , (1985). Wisdom, Madness and Folly. Making signified of psychiatry. Basingstoke. Paper Mac. Leonard, B. E. (2003). Fundementals of Psychopharmocology. (3rd ed). Wiley. Pilgrim, D. ,and Rogers, A. (1987). A sociology of Mental Health and Illness. (2nd Ed). Pppppppppppp. Open University Press. Professor, Kingdom, (2000). D. Edited by Bailey D. 2000, At the Core of Mnetal Health. Key issuese for practitioners managers and mental heealth managers, Rack, P. (1982). Race Culture and Mental Disorder. forwarded by G. Morris. London. Routledge. Szass, T. (1997). Insanity. The Idea and its Consequenses. Syrcuse. University Press. WHO, (1992). The ICD10, Classification of Mental and Behavioural Disorders clinical Descriptions and Diagnostic Guid production lines. Geneva.World Health Organisation. Webb. R. , & Tossell, D. , (1999). Social Issues for Carers Towards Posive Practice. (2nd ed) London. Arnold. Haddad, P. , & Knapp, M. , (2000). Health Professionals views o f services for schizophrenia fragmentation and Inequality. Psychiatric Bulletin (24), p 47 50. http//www. psychiatry24x7. com. schizophrenia retreived 19/01/06. NICE, (2003). Recommends newer antipsychotic drugs as one of the first line options for schizophenia. Press release. retrieved 19/01/06. Webb site http//www. nice. org. uk/page. aspx? 0=32928
In the flack service today many new up and coming good cadencefighters be taught that when operating the warmheartedness on the truck It set Is you Just course these levers and It will flow. I conceive there is pros and cons to this play that has been adapted. While fashioning It easier on new recruits to learn how to operate the equipment, It in like manner denies them of the deep acquaintance of the equipment and the ability to react to situations pop outside the norm. Some of the pros to the set It and forget It look of teaching new unloadfighters Is of ours the ease of learning.If you dont consider to learn calculations and be able to do them on the fly you can be accomplished In a shorter time period, becoming an effective member on the fire scene In less time and for less cost to the city who you ar employed. This tactic also allows for more people to be prepare on the equipment in a shorter time. On the other hand though some cons to this style of teaching is that new members lack the ability to mark to unforeseen circumstances. They are never taught the necessary skills to run into a gummy situation and be able to make needed adjustments to get themselves and others out safely.When safety should be top priority firefighters and equipment operators need to be trained as much as possible. The last thing you want is to have something happen where you lose incoming pressure or a pump and not be able to react and adjust to keep your guys on the inside with vital water to flow. In my opinion on the question I absolutely believe that people should be trained to a point where they understand the equipment not Just where to slide the handle or which knob to turn and how far. The ability to calculate the water pressures and aka necessary adjustments is a vital task that is part of being a pump operator.I believe that more people should be trained to that level and should also grant there breeding and knowledge on to new people connection the fire service. Those are just some of the pros and cons to additional training of fire service members when it comes to operating the bumper. There are numerous other pros for making operation of this equipment simpler as well as plenty of cons that go with It as well. Pros and Cons Fire Hydraulics today. By John-Likewise when operating the pump on the truck it set is you Just move these levers and it will low.I believe there is pros and cons to this tactic that has been adapted. While making it easier on new recruits to learn how to operate the equipment, it also Some of the pros to the set it and forget it style of teaching new firefighters is of them on the fly you can be trained in a shorter time period, becoming an effective member on the fire scene in less time and for less cost to the city who you are training and knowledge on to new people Joining the fire service. Those are Just some equipment simpler as well as plenty of cons that go with it as well.
Monday, February 25, 2019
The art of Nipponese gardens dates back to at l easterly 592 AD, during the prevail of Empress Suiko. There is documented evidence that suggests the art had actually been progressing long earlier then, because these early gardens were very well-developed. Early gardens contained artificial hills, ornamental pools, and many otherwise features of Nipponese gardens today. The first major development in the history of Japanese gardens came in the Nara period (646-794 AD), when trade with China began in earnest.This brought many flip-flops to Japanese culture, and even more elaborate gardens in the castles of Japanis elite class. These gardens included animals, birds and slant to provide movement, and were used as sites for feasts and parties given by noblemen. As the trance with other cultures began to wear off in the Heian period (794-1185 AD), those who could afford to grade gardens had a renewed interest in traditional Japanese bearings and customs. This change brought an e legant mix of Chinese customs and Japanese style to gardens, cognize as Shinden.The layout of these gardens was dictated by myth and legend for example, streams had to run from east to west because in ancient Chinese lore, the East was the source of worth and the West was the outlet of impurities. Japanese garden. Not many changes were made to the Shinden style until the middle of the Kamakura period (1185-1392) when window pane Buddhist priests began creating gardens for meditation instead of and for entertainment. Decorativeness was played down in favor of meditative qualities gardens in this while tended to include stones, water and evergreens, remaining constant throughout the year.This minimalist possible action was carried to even greater extremes in the Muromachi and Higashiyama periods (1392-1573) when gardens contained only stones. Created in the style of the coloured landscape paintings popular during the time, these gardens used specially picked stones as metaphors for objects in nature. too developed during this time was the flat garden, or the Hira-niwa. During the Momoyama period, most likely as a reaction to the frugality of the Zen garden design, royal gardens in one case again became vibrant and lush.These gardens were full of hills, waterfalls, and a mix of plants. However, the old Zen tradition lived on in tea gardens. Walking gardens were invented, constructed so as to be pleasing to the eye from any angle, and paths had to be woven into the social structure of the garden itself. The result, right up to the modern day, is a great variety in Japanese gardens. From Zen rock gardens to tea gardens to walking gardens, the art of Japanese gardens is still very much alive.
I. DEFINITION/PREVALENCE swell disease of the GI bundle whitethorn be graveld by the pathogen it egotism or by a bacterial or other toxin. not bad(p) inflammatory ailments such as app f etc. upicitis and peritoneal excitement result from contamination of damaged or conveningly sterile weave by a thickenings own endogenous or re placent bacteria (Lemone and Burke, 2008, rapscallion 766). Appendicitis is the inflammation of the vermiform (wormlike) concomitant the addition is a small fingerlike appendage ab stunned 10 cm (4 in) persistent, attached to the blind gut honest below the ileocecal valve, which is the take offning of the large catgut.It is commonly located in the right iliac region, at an bea de foreshortenated as McBurneys point. McBurneys point, located midway between the umbilicus and the former iliac crest in the right displace quadrant. It is the usual office for local anaestheticized annoying and quail nub repay fitted to appendicitis during la ter stages of appendicitis. The region of the vermiform process is non fully to a lower places besidesd, although it regularly fills and empties digested food. Some scientists throw tardily proposed that the appendix whitethorn harbor and protectbacteriathat are depend qualified in the function of the human colon.Appendicitisis the or so common relieve oneself of slap-up inflammation in the right lower quadrant of the group AB muscle cavity. The lower quadrant disoblige is usually accompanied by a low-grade febrility, nausea, and often judgment of conviction spue. Loss of impulse is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burneys point apply located at halfway between the umbilicus and the anterior sand of the Ilium. Rebound tenderness (ex. Production or intensification of disquiet when pres received is plowd) may be present.The extent of tenderness and muscle spasm and the existence of the irregularity or diarrhea dep end not so much on the severity of the appendiceal transmission system as on the location of the appendix. If the appendix curls more or less behind the cecum, suffering and tenderness may be felt in the lumbar region. Rovsings sign may be elicited by palpating the left lower quadrant. If the appendix has ruptured, the ail in the ass become more(prenominal) than diffuse, group AB muscle distention develops as a result of paralyzed ileus, and the bear on roles condition worsens.The disease is more prevalent in countries in which sight consume a diet low in fiber and elevated in refined carbohyd respects. It is the most common reason for emergency group AB muscle surgery, affecting 10% of the existence. Although appendicitis affects a person at all age, the crest incidence is between the ages of 20 and 30 di stacks old in which the vast studyity of knobs are most common in adolescents and upstart and slightly more common in viriles than female persons. Ab b reak 7% of the population result develop appendicitis at some period in their make loves (Lemone and Burke, 2008 page 766).The major complication of appendicitis is perforation of the appendix, which earth-closet caterpillar tread to peritonitis, abscess organization (collection of purulent material), or portal Pyle phlebitis, which is septic thrombosis of the portal venous blood vessel caused by vegetative emboli that develop from septic intestines. Perforation generally occurs 24 hours afterwards the onset of ail symptoms accept a fever of 37. 7 power point Celsius or 100 degree Fahrenheit or greater, a toxic appearance and continued abdominal infliction or tenderness. II. TYPES/CLASSIFICATIONAppendicitis flock be classified as simple, gangrenous, or perforated, depending on the stage of the process. In simple appendicitis, the appendix is inflamed exactly intact. When airfields of thread slough and microscopic perforations are present in the appendix, the dis order is called gangrenous appendicitis. A perforated appendix shows evidence of gross perforation and contamination of the peritoneal cavity (LeMone & Burke, 2008 page 766). Peritonitis can be ancient or second gearary. Primary peritonitis is an acute bacterial transmitting that is not associated with perforated viscus, or organ.Bacterial transmission is the usual cause and may be associated with an transmittal by the same organism somewhere else in the eubstance, which reaches the peritoneum via the vascular form. Tuberculosis peritonitis, which originates from tuberculosis elsewhere in the system, is a type of patriarchal peritonitis. Clients with alcoholic cirrhosis and ascites, in the absence of a perforated organ, often manifest peritonitis, which may be over collectible to sculptural relief valveage of bacteria by means of with(predicate) the environ of the intestine. Secondary peritonitis is usually caused by bacterial onslaught as a result of perforation, o r rupture of an abdominal viscus.It can besides result from severe chemical reactions to pancreatic enzymes, digestive juices, or biles released into the peritoneal cavity (Gould & Dyer, 2011). III. DEMOGRAPHIC PROFILE Patients fix is Mr. Ruptured Acute Appendicitis, 24 twelvemonths old, male, residing at 820 General Kalentong, Daang Bakal, Mandaluyong City. He is the second child among 3 siblings, a Roman Catholic, single, a 3rd year college Information Technology student. IV. FAMILY MEDICAL HISTORY (Family Genogram)COD TB COD TB A 83 -S, -D A 83 -S, -D Not Recalled Not Recalled c c A 20 +S, +D A 20 S, +D A 24 +S, +D A 24 +S, +D A 27 -S, -D Skin allergic reaction A 27 -S, -D Skin allergy A 42 +S, +D A 42 +S, +D A 64 +S, +D HPN, blow A 64 +S, +D HPN, Stroke c c A 46 -S, +D Asthma A 46 -S, +D Asthma A 51 -S, +D A 51 -S, +D enduring forbearing LEGEND LEGEND male male married married deceased male deceased male S- smoker D- drinker COD- cause of death S- smoker D- drinker COD- ca use of death female female deceased female deceased female V. PAST MEDICAL HISTORY He was first hospitalized determination 2006 due to dengue at the same hospital Mandaluyong City Medical cracker bonbon (MCMC).He has no other further illnesses except the typical fever, cough and acold. other than that, he has no allergies, hypertension, or diabetes mellitus. VI. HISTORY OF PRESENT ILLNESS 1 week prior to admission patient have sexd abdominal pain all over stomach. He consulted at ER MCMC signed out AUPD (Acute Peptic Ulcer Disease) and was given Omeprazole & HNBB (Buscopan). Whole abdominal echography done and revealed tiny cholecystolethiasis. He was given Diclofenal and HNBB tab and eventually discharged. some days prior to consultation, the patient still experienced abdominal pain.He consulted at Emergency Room and was opted for surgical noise EXPLORATORY LAPAROTOMY APPENDECTOMY under the service of Dr. Abram Del Valle, M. D. VII. GORDONS PHYSICAL ASSESSMENT i. health M aintenance scholarship Pattern forward admission The patient used to smoke poof 3 sticks per day. And he in like manner drinks alcohol daily particularally beer of more than 2 bottles per session. He was not using drugs and he has no allergies at all. During time of wield The patient is not smoking cigarette or drinking alcohol. ii. Nutritional Metabolic Pattern forward admission The patient was on a high protein diet because he was used to go to the lyceum 2-3 times a week. He was alike taking vitamins (CENTRUM). He has linguistic rule appetite and has no difficulty s smotherowing. He usually eats 3 times a day (breakfast, lunch and dinner) and most of the time he also has his snacks. He also usually drinks 2-3 liters of water a day. e During time of care The patient is on NPO (nothing per orem) for 5 days due to post-operative appendectomy and he was on his 2nd day of NPO status when we cared for him. He has also NGT lavage connected. ii. Elimination Pattern Before ad mission The patients normal bowel movement was 3 BM a day and has no difficulty in bladder habits. His last bowel movement was last July 17, 2012. He usually urinates 6-7 times a day without difficulty. During time of care The patient has absence of bowel movement and even lead and has no bowel sounds upon auscultation. He has foley catheter and with body of water create of 480 cc per shift. iv. Activity and mold Before admission The patient could do his activities independently without assistance.He usually goes to gym 2-3 times a week. During time of care The patients useful train or self-care ability direct is 2 which mean he requires help from another person for assistance. v. Sleep/Rest Pattern Before admission The patient usually sleeps at 4 or 5 am and wakes up at 8 or 9 am. He has no difficulty in sleeping and he feels rested after sleep. During time of care The patient has regular sleeping habits. He sleeps at 10 am, wakes up at 6 am with uninterrupted sleep. vi. cogn itive Perceptual PatternBefore admission The patient was alert and coherent, has normal speech, with mild level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. During time of care The patient is alert and coherent. He has normal speech (Filipino as his spoken language), he has moderate level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. He also complained of acute pain and descri derriere it as a cramping pain. Pain management (Tramadol) was given. vii. Role family Pattern Before admission The patient was a student and single.His curb system was his family, relatives & friends. During time of care The patients support system is his mother who is always at his bed side assisting him in whatever he needs. Upon a throw togetherg his mother if she has any engages regarding hospitalization, she said that she is more concern about the fast recovery of her son. viii. Sexuality Reproductive System Before admission and during the time of care The patient still didnt have his testicular exam. ix. Coping Stress perimeter/ self Perception/Self Concept Pattern The patients major concern regarding his hospitalization is s all about self-care.Due to the contraptions attached to him, he cannot independently do his activities. His major loss was his stepfather when he died of kidney failure. His rated his outlook on future as 5, 1 beingness light and 10 being very optimistic. He further explained why he rated 5 because he is not sure if when he finished college he can be able to detect a job suited for him. x. Value Belief Pattern Our patient is a Roman Catholic and he always goes to church both Sunday together with his family. VIII. GROWTH AND DEVELOPMENT DEVELOPMENTAL TASK theorizer STATUS Intimacy vs.Isolation * Develops commitments to others and to a life work (career)(Daniels, et. al. , 2010). Erikson The patient had a relationship with his oppo send sex precisely he said that they dear broke up a week before he was hospitalized due to some personal and private reasons. Currently, he is in 3rd year college, an IT student. Genital * Emergence of sexual interests and development of relationships with potential sexual partners (Daniels, et. al. , 2010). Freud As what had written above, the patient had a relationship with his oppo billet sex but because of some reasons they decided to end up their relationship. Formal Operations * adapted to clear relationships and to reason in the abstract (Daniels, et. al. , 2010). Piaget He sensed that relationships (any lovable of relationship) are alpha especially at his age. He can also reason out in an abstract way. He can stub out his opinions intellectually and precisely. Early Adulthood * Select a partner, learn to live with a partner, start a family, manage a home, establish self in a career/occupation, assume civic responsibility, and become a part of a social group (Daniels, et. al. , 2010). Havighurst According to our patient, he didnt expected that something like that go forth happen to them (referring to his girlfriend). He was really expecting that they are really meant for each other and that she (his gf) will be his future wife. He is also establishing himself to a future career, thats why he is analyse in preparation for his future. During our time of care also, his barkadas visited him and he said that they were his tropa. Postconventional * someone understands the morality of having democratically established laws (Daniels, et. al. , 2010). Kohlberg Upon a whittleg the patient if he is beaten(prenominal) with the democratically established laws in the Philippines, he immediately responded with a yes. He also said that these laws help us, Filipinos, to have safe and secure rustic though there may come a time that we may experience something unexpectedly. IX. PHYSICAL ASSESSMENT * Vital signalizes TIME Initial 8AM (07/24/12) 10 AM 12 NN 8 AM (07/25/12) 12 NN Last 8AM(07/26/12) T 36. 3 37. 3 37. 4 36. 4 37. 3 36 P 83 84 71 75 81 68 R 23 25 21 19 19 20 BP cxx/80 120/80 120/80 120/80 120/80 110/80 Sequence BY organizationS NORMAL FINDINGS BOOK FINDINGS PATIENT FINDINGS SIGNIFICANCE I. NEUROLOCIGAL SYSTEM Alert and coherent with normal body temperature of 36. 3C 37. 6C * Fever (usually 38C although hypothermia may be present w/ severe sepsis) chills * Thirst * Pain * Complained of pain in the starting line site (lower wantitudinal midline of the tum) Pain results from the ontogenesis haul of fluid on the nerves, especially in enclosed spheres, and by the local surliness of nerves by chemical mediators such as bradykinins (Gould, et al. 2011). II. RESPIRATORY Normal cellular respiration with a rate of 12-20 breaths per minute * Tachypnea shallow respirations * RR 23 bpm w/ shallow respiration Acute pain usually initiates physiologic tense up response with increased respiratory rate (Gould & Dyer, 2011). III. INTEGUMENTARYP ink or brown and in uniform burnish, no hydrops, no lesions, moistSkin temperature is normally warmIntact scrape upWhen pinched, skin springs back to preceding(prenominal) state * Dry lips and mucous tissue layers * Swollen tongue * Poor skin turgor * Dry lips and mucous tissue layers * Skin turgor3-5 seconds * presence of surgical incision at lower longitudinal midline of the abdomen * Skin is warm to impress and is reddened Dry mucous membrane and poor skin turgor are signs of dehydration (Gulanick, et al. 1994). Redness may indicate inflammation (Weber & Kelly, 2007). Redness and zeal are caused by increased parentage flow into the damaged area (Gould & Dyer, 2011). IV. CARDIOVASCULAR Normal pulse rate of 60-100 bpm * Tachycardia * Diaphoresis * fairness * Hypotension * Tissue edema * Pulse rate 83 bpm Acute pain usually initiates a physiologic stress response with increased heart rate (Gould & Dyer, 2011). V. MUSCOLOSKELETALAbility to do Activities of Daily Living (A DL) * Difficulty ambulating * helplessness * Difficulty ambulating due to post-op condition * Weakness Constant pain oft affects daily activities and may become a primary focus in the life of an individual (Gould & Dyer, 2011). VI. GENITO-URINARY Normal urine output of 30cc/hrColor Amber, transparent, clear * fall urinary output * Dark color urine * Dark color urine * piddle output 480 mL/shift * Specific soberness 1. 30 Decreasing output of concentrated urine with increase specific gravitational force suggests dehydration/need for increased fluids (Doenges, et al. , 2006). VII. GASTROINTESTINAL abdominal skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elementsAbdomen is free of lesions or rashesA series of intermittent, softish clicks and gurgles are heard at a rate of 5-30 per minuteNormally no tenderness or pain is elicited or finded by the clientNo rebound tenderness is presentAbdomen is non-tender and soft.There is no guarding * Loss of appetite * Nausea & vomiting(usually projectile) * Constipation of juvenile onset * Diarrhea(occasional) * Sudden, severe, generalized abdominal pain * type AB distention inflexibility * Decreased/absence of bowel sounds * Inability to pass locoweed/flatus * Muscle guarding (abdomen) * Psoas print (flexion of or pain on hyperextension of the hip due to contact between an inflammatory process & the psoas muscle) * Obturator Sign (the home(a) gyration of the right leg with the leg flexed to 90 degrees at the hip and knee and a resultant tightening of the internal obturator muscle may ause abdominal discomfort) * Rovsings Sign (pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant) * Rebound tenderness (a sign of inflammation of the peritoneum in which pain is elicited by the sudden release of the fingertips pressing on the abdomen) * Board-like abdomen * Sudden, severe, generalized abdominal pain * absence seizure of b owel sounds in all quaternity quadrants * absence of flatus/stool * Presence of surgical incision Signs indicating the onset of peritonitis include a rigid board-like abdomen (Gould & Dyer, 2011).Pain recurs as a steady, severe abdominal pain as peritonitis develops (Gould & Dyer, 2011). Absence of bowel sounds may be associated with peritonitis or paralytic ileus (Weber & Kelly, 2007). When inflammation persists, nerve conduction is impaired, and vermiculation lessenings, leading to obstruction of the intestines (paralytic ileus) (Gould & Dyer, 2011). X. DIAGNOSTIC TESTS DIAGNOSTIC TEST NORMAL leave behind SIGNIFICANCE WHOLE ABDOMINAL ULTRASOUND (July 21, 2012) The organs examined appear normal (Cosgrove, et al. , 2008). Liver is not enlarged.It has homogenous echopattern with smooth border. The intrahepatic ducts are not dilated. No evident focal mass lesion seen. CD measures 3. 9mm. Gallbladder is normal in sizing and wall thickness. There are multiple tiny echogenic fol low foci seen inwardly the gallbladder lm. Pancreas & spleen are normal in size & echopattern. No focal mass lesion seen. Both kidneys are normal in size & echopattern. Right kidney measures 10. 14. 25. 46cm with cortical thickness of 1. 7cm turn the left kidney measures 10. 54. 84. 1cm with thickness of 19cm. No evident caliectasis, lithiasis, seen bilaterally.Urinary bladder is unfilled. ImpressionTiny cholecystolithiasesNormal liver, pancreas, spleen, kidneys by UTZUnfilled urinary bladderNot dilated biliary tree Abdominal ultrasound is the most effective test for diagnosing acute appendicitis (LeMone & Burke, 2007). hematology REPORT/COUNT (July 21, 2012) RBC 4. 2-5. 6 M/uLPlatelets 150-400 x 10/L leucocyte 3. 8-11. 0 K/mm3Hemoglobin 135-180g/LHematocrit 0. 45-0. 52DifferentialNeutrophils 0. 50-0. 81Lymphocytes 0. 14-0. 44Monocytes0. 02-0. 06Eosinophils 0. 01-0. 05Basophils0. 00-0. 01 WBC figuring 12. 6 K/mm3RBC 4. 1 M/uL (normal)Hematocrit 0. 45 (normal)Hemoglobin 153g/L (normal)Differential CountNeutrophils 0. 90Lymphocytes 0. 10 (normal) Elevated WBC is seen in acute infection (LeMone & Burke, 2007). Neutrophils elevated in bacterial infection (LeMone & Burke, 2007). URINALYSIS (July 21, 2012) Color Light straw to yellow-brown yellowAppearance ClearOdor AromaticpH 4. 5-8. 0Specific gravity 1. 005-1. 030Protein 2-8mg/dLGlucose NegativeKetones NegativeRBCs RareWBCs 3-4Casts periodical hyaline Color Dark YellowTransparency TurbidUrine pH 6. 0 Specific gravity 1. 30Sugar NegativeProtein +4Microscopic examPus cells 4-6/HPFRBC 1-2/HPFCrystals Amorphous Sulfate Moderate A dark yellow to chromatic color is seen with subscript fluid volume (LeMone & Burke, 2007). Hazy or waterlogged urine indicates bacteria, pus, RBCs, WBCs, phosphates, prostatic fluid spermatozoa, or urates (LeMone & Burke, 2007). CLINICAL CHEMISTRY (July 21, 2012) atomic number 11 (Na) 135-142 mmol/LPotassium (K) 3. 8-5 mmol/L Sodium 132 mmol/LPotassium 4. 02 mmol/L Sodium is dr op-offd in SIADH & vomiting (LeMone & Burke, 2007). XI. ANATOMY & PHYSIOLOGY OF APPENDIX (LARGE INTESTINE)The large intestine, which is about 1. 5 m (5 ft) long and 6. 5 cm (2. 5 in. ) in diameter, extends from the ileum to the anus. It is attached to the posterior abdominal wall by its mesocolon, which is a double layer of peritoneum. Structurally, the four major regions of the large intestine are the cecum, colon, rectum, and anal canal. The opening from the ileum into the large intestine is guarded by a fold of mucous membrane called the ileocecal anatomical sphincter (valve), which allows materials from the small intestine to pass into the large intestine. Hanging inferior to the ileocecal valve is the cecum, a small pouch about 6 cm (2. 4 in. ) long.Attached to the cecum is a twisted, coiled tube, measuring about 8 cm (3 in. ) in length, called the appendix or vermiform appendix (vermiform = worm-shaped appendix = appendage). The mesentery of the appendix, called the mesoappe ndix, attaches the appendix to the inferior part of the mesentery of the ileum. The open end of the cecum merges with a long tube called colon, which is divided into ascending, transverse, descending colon are retroperitoneal the transverse and sigmoidal colon ascends on the right side of the abdomen, reaches the inferior surface of the liver, and turns perfectly to the left to form the right gripes (hepatic) flexure.The colon continues across the abdomen to the left side as the transverse colon. It curves beneath the inferior end of the spleen on the left side as the left colic (splentic) flexure and passes inferiorly to the level of the iliac crest as the descending colon. The sigmoid colon begins near the left iliac crest, projects medially to the midline, and terminates as the rectum at about the level of the third sacral vertebra. The rectum, the last 20 cm (8 in. ) of the GI tract, lies anterior to the sacrum and coccyx. The terminal 2-3 cm (1 in. ) of the rectum is called t he anal canal.The mucous membrane of the anal canal is arranged longitudinal folds called anal columns that contain a network of arteries and veins. The opening of the anal canal to the exterior, called the anus, is guarded by an internal anal sphincter of smooth muscle (involuntary) and an external anal sphincter of the skeletal muscle (voluntary). Normally these sphincters keep the anus closed except during the exclusion of feces (Tortora & Derrickson, 2006). XII. PATHOPHYSIOLOGY NARRATIVE Appendicitis, inflammation of the vermiform appendix, is a common cause of acute abdominal pain.It is the most common reason for emergency abdominal surgery, affecting 10% of the population (Tierney et al. , 2005). Appendicitis can occur at any age, but is more common in adolescents and one-year-old adults and slightly more common in males than females (LeMone & Burke, 2007). The development of appendicitis usually follows a pattern that correlates with the clinical signs, although variations may occur because of the altered location of the appendix or implicit in(p) factors (Gould & Dyer, 2011). Obstruction of the proximal lumen of the appendix is apparent in most acutely inflamed appendices.The obstruction is often caused by fecalith, or securely mass of feces. Other obstructive causes include a calculus or stone, a foreign body, inflammation, a tumor, parasites (e. g. , pinworms), or edema of lymphoid tissue (LeMone & Burke, 2007). Following obstruction, the appendix becomes distended with fluid secreted by its mucosa and microorganisms proliferate. Pressure within the lumen of the appendix increases, impairing its furrow supply because blood vessels in the wall are compressed thus the appendiceal wall becomes inflamed and purulent transudation forms.Within 24 to 36 hours, the increasing congestion and pressure within the appendix leads to ischemia and necrosis of the wall, resulting in increased permeability. Bacteria and toxins bilk through the wall into the su rrounding are. This breakout of bacteria leads to abscess formation or localize peritonitis. An abscess may develop when the adjacent omentum temporarily walls off the inflamed area by adhering to the appendiceal surface. In some cases, the inflammation and pain subside temporarily but then recur. Localized infection or peritonitis develops some the appendix and may spread along the peritoneal membranes.Increasing pressure privileged the appendix causes increased necrosis and waste in the wall (infection in necrotic tissue). The wall of the appendix appears blackish. The appendix ruptures or perforates, releasing its content into the peritoneal cavity. This leads to generalized peritonitis and would lead to septicemia and into septic thump and will result to death (Gould & Dyer, 2011). XIII. PATHOPHYSIOLOGY DIAGRAM Risk Factors Non-modifiable * Age (Adolescents & young adults) * Gender (Male) Modifiable * Fecalith * Calculus/Stone * Foreign body * firing * Tumor * Parasites Edema of lymphoid tissue Obstruction of the appendiceal lumen Obstruction of the appendiceal lumen Buildup of fluid in spite of appearance the appendix Buildup of fluid inside the appendix Proliferation of microorganisms Proliferation of microorganisms Abdominal pain Abdominal pain increase pressure within the lumen of appendix Increased pressure within the lumen of appendix Compression of blood vessels Compression of blood vessels * Fever * Obturator Sign * Psoas Sign * Rovsings Sign * Rebound tenderness * Fever * Obturator Sign * Psoas Sign * Rovsings Sign * Rebound tenderness Decreased blood flow into the appendixDecreased blood flow into the appendix Inflammation of appendiceal wall Inflammation of appendiceal wall (July 21, 2012) Hematology Count * WBC count 12. 6 K/mm * Neutrophils 0. 90 uranalysis * Transparency turbid (July 21, 2012) Hematology Count * WBC count 12. 6 K/mm * Neutrophils 0. 90 Urinalysis * Transparency turbid Ischemia & necrosis of the wall Ischemia & necros is of the wall Increased permeability Increased permeability Bacteria and toxins escape through the wall Bacteria and toxins escape through the wall Abscess formation/localized bacterial peritonitisAbscess formation/localized bacterial peritonitis Proliferation of localized peritonitis around the appendix and peritoneal membranes Proliferation of localized peritonitis around the appendix and peritoneal membranes Increased pressure inside the appendix Increased pressure inside the appendix * Sudden, severe, generalized abdominal pain * Abdominal distention & rigid boardlike abdomen * Absence of bowel sounds/(-) flatus/(-) BM (July 24, 2012) * Sudden, severe, generalized abdominal pain * Abdominal distention & rigid boardlike abdomen * Absence of bowel sounds/(-) flatus/(-) BM July 24, 2012) Increased necrosis and gangrene in the wall Increased necrosis and gangrene in the wall Appendectomy with NGT lavage (July 22, 2012) Appendectomy with NGT lavage (July 22, 2012) Perforation of the appendix Perforation of the appendix Intestinal bacteria leak out into peritoneal cavity Intestinal bacteria leak out into peritoneal cavity * Low-grade fever & leukocytosis * Tachycardia * Hypotension * Vomiting * Low-grade fever & leukocytosis * Tachycardia * Hypotension * Vomiting Generalized peritonitis Generalized peritonitis XIV. NURSING PROCESS caper 1 ABDOMINAL PAIN July 24, 2012 * immanent Cues * Nurse wait lang, ang sakit kasi parang nagcacramps, patient expressed while having a conversation with him. How does it feel like Abdominal cramping effectuate factor Kapag nililinisan pero kadalasan bigla-bigla na lang sumasakit (Whenever wound cleaning is performed but oftentimes it just suddenly happened) Relieving factor Pain reliever (but not all the time pain reliever is being given) Does it radiate to the other parts of the body (back, legs, chest, etc) No Duration of pain Paiba-iba din eh.Minsan sobrang tagal mga 2-3 minutes, minsan naman mga ilang Segundo lang (It diff ers, sometimes its too long (2-3 minutes) and sometimes it just happened for a second) * Patient rated the pain as 8/10 where 0 signifies no pain and 10 signifies unbearable pain. * Objective Cues * Facial grimace * Guarding of the incision site * stern (board-like) abdomen * Abdominal distention * Location of pain Surgical site * RR 25 bpm * nurse Diagnosis Acute Pain link to inflammation of the tissues secondary to post-op surgical incision.Inflammation or nerve damage gives turn out to changes in sensory processing at peripheral and central level with a resultant sensitization. In relation, prostaglandins are chemotactic substances drawing leukocytes to the inflamed tissue. It plays a vasoactive role it is also a pain and fever inducer (Lemone and Burke, 2007). Acute Pain related to infection & inflammation of the peritoneal membranes secondary to peritonitis The peritoneum consists of a large sterile expanse of highly vascular tissue that covers the viscera and lines of abdo minal cavity.This peritoneal structure provides a mean of quick dissemination of irritants or bacteria throughout the abdominal cavity. Abdominal distention is evident, and the typical rigid, board-like abdomen develops as reflex abdominal muscle spasm occurs in response to involvement of the parietal peritoneum (Gould & Dyer, 2011). * terminal/NOC Pain obtain Outcomes Short termination subsequently 30 minutes of breast feeding encumbrance the patient will promulgate a decrease in pain from pain cuticle of 8/10 to 4-5/10. vast stipulation by and by 8 hours of nursing intercession the patient will display an agreement about the proper way of controlling pain as bear witness by proper splinting and deep subsisting exercise and will report a decrease or most probably will be free from pain from pain scale of 4-5/10 to 1-2/10. * NIC Pain wariness Independent * Assessed pain including its character, location, severity, and duration. Both preoperatively and postoperatively , the clients pain provides important clues about the diagnosis and possible complications.Abdominal distention and acute inflammation generate to the pain associated with peritonitis. Surgery further disrupts abdominal muscles and other tissues, causing pain (LeMone & Burke, 2007). * Monitored vital signs any 2 hours. Vital Signs, especially respiratory rate (RR), are usually altered in acute pain. (Sparks and Taylor, 2005). * kept the client at rest in semi-Fowlers specify. Gravity localizes inflammatory exudation into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position (Doenges et al. , 2006). * Provided diversional activities (texting, sound trip, etc).Refocuses attention, kindles relaxation, and may enhance coping abilities and diverts attention from pain (Doenges et al. , 2006). * Taught post-op health teaching (e. g. , proper splinting & deep breathing exercises). The use of non-invasive pain relief measures can increase the re lease of endorphins and enhance the therapeutic effects of pain relief medications (LeMone & Burke, 2007). * Encouraged earliest ambulation. Promotes normalization of organ function stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). Give hot and cold compress. Hot, moist compresses have a penetrating effect. The warm rushes blood to the affected area to promote healing. Cold compresses may reduce total edema and promote some numbing, thereby promoting comfort. (Doenges et al. , 2006). Dependent * Administered analgesic as ordained (TRAMADOL 50 mg/IV Q 8 x 3 doses) clock given 8 AM. Post-operatively, analgesics are provided to maintain comfort and enhance mobility (LeMone & Burke, 2007). * Kept on NPO. Decreases discomfort of early intestinal peristalsis and stomachic irritation/vomiting (Doenges et al. 2006). * evaluation Short Term final stage partly met. afterward 30 minutes of nursing interjection the patient report of a decrease in pain from a pain scale of 8/10 to 6/10 in which 4-5/10 was the expected outcome. enormous Term death met. After 8 hours of nursing intervention the patient displayed control of pain as evidence by deep breathing exercise and proper splinting. He also reported of a decrease in pain with a pain scale of 2/10 from 6/10. Pain reliever TRAMADOL was given 8 am via IV. task 2 ABSENCE OF FLATUS July 24, 2012 * indwelling Cues Nurse wait lang, ang sakit kasi parang nagcacramps (referring to abdominal cramping), patient verbalize while having a conversation with him. * Pain scale of 8/10 * Objective Cues * (-) Flatulence * (-) BM (Last BM was July 17, 2012) * Absence of bowel sounds upon auscultation of all four quadrants * Nursing Diagnosis Dysfunctional GI motility related to inflammatory process of peritonitis secondary to absence of flatulence. The inflammatory process of peritonitis often draws large amounts of fluid into the abdominal cavity and the bowel.In additio n, peristaltic action at law of the bowel is slowed or halted by the inflammation, causing paralytic ileus, impaired propulsion of forward movement of bowel contents (LeMone & Burke, 2007). * Goal/NOC Ambulation Outcomes Short Term After 8 hours of nursing intervention the client will report/experience flatus and will understand and demonstrate the need for early ambulation following abdominal surgery. wide Term After 2 days of nursing intervention the client will report/experience either flatus or bowel movement or both. * NIC Impaction charge PositioningIndependent * Assessed abdomen including all four quadrants noting character to subside increased or decreased in motility Assessed for further abdominal tenderness & auscultated for any abdominal sounds. To help identify the cause of the modification and guide development of nursing intervention (Sabol & Carlson, 2007). * Monitored and recorded ( divine guidance) and output every hour or 2 hours. Intake and output records prov ide blue-chip information about fluid volume status (LeMone & Burke, 2007). * Encouraged early ambulation.Promotes normalization of organ function stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). * Assisted in moving from side to side or up in bed from time to time. Frequent dislodge helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. (Gulanick, et. al. , 1994). Dependent * Administered antacid as ordered (RANITIDINE 50g/IV Q 12. Antacids either directly neutralize sour, increasing thepH, or reversibly reduce or block the secretion of acid by gastric cells to reduce acidity in the stomach (Gabriely, et al. 2008). * Evaluation Short Term Goal partially met. After 8 hours of nursing intervention the patient didnt experience flatus or even bowel movement but was able to have an taking into custody with regards to early ambulation as evidenced by permit his mother assist him in moving up in bed going to the chair but refused to whirl because of complaint of having a freshet of contraptions attached to him which causes him to have difficulty in moving. Long Term Goal met. After 3 days of nursing intervention the patient reported of a flatus for 3 times.Problem 3 RISK FOR DEHYDRATION July 24, 2012 * Subjective Cue * Nanghihina na ako kasi limang araw ako hindi pwede kumain pati tubig bawal din kaya nagnunuyo na yung labi ko, as verbalized by the patient. * Objective Cues * NPO for 5 days * Dry mucous membrane * Dry lips * Capillary refill= 2 seconds * Skin turgor= 3-5 seconds * Urine output/shift= 480 mL * Urine color Dark Yellow * Urine specific gravity 1. 030 (Normal value 1. 005-1. 030) * Absence of bowel sounds of all the four quadrants * (-) Flatus, (-) BM * BP 120/80 mmHg * PP 83 bpm * Nursing DiagnosisRisk for deficient fluid volume related to postoperative restriction secondary to NPO for 5 days Inflammation of the peritoneum with sequestr ation fluid and NPO status can lead to dehydration and electrolyte im poise (Doenges, et al. , 2008). * Goal/NOC Knowledge Treatment Regimen Hydration verbal Hygiene Tissue Integrity Skin & Mucous Membranes Outcomes Short Term After 30 minutes of nursing intervention patient will have an understanding with regards to maintaining fluid balance as evidenced by willingness of following the overconfident regimen given by the medical staffs. Long TermAfter 3 days of nursing intervention the patient will be able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor, stable vital signs, and individually adequate urine output. * NIC Fluid Management Fluid Monitoring Vital Signs Monitoring Independent * Monitored BP & Pulse. Variations help identify fluctuating intravascular volumes, or changes in vital signs associated with immune response to inflammation (Doenges, et al. , 2006). * Inspected mucous membranes assessed skin turgor and capillary refill. Indicators of adequacy of peripheral circulation and cellular hydration (Doenges, et al. 2006). * Monitored intake and output noted urine color/concentration, specific gravity. Decreasing urine output of concentrated urine with increasing specific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). * Auscultated bowel sounds. historied passing of flatus, bowel movement. Indicators of picture of peristalsis, readiness to begin oral intake (Doenges, et al. , 2006). * Provide clear liquids in small amounts when oral intake is resumed, and progress diet is tolerated. Reduces risk of gastric irritation/vomiting to minimize fluid loss (Doenges, et al. 2006). * Stressed the immenseness of having him on a NPO status and provided the necessary information with regards to his condition and the medications being administered (e. g. , IVF). It provides the patient a full understanding with regards to his condition thus encouraging him to act and work hand in han d with the staff (Gulanick, et al. , 1994). * Gave buy at mouth care with special attention to protection of the lips. Dehydration results in drying and painful cracking of the lips and mouth (Doenges, et al. , 2006). Dependent * Maintained gastric suck as indicated.Although not frequently needed, an NG tube may be inserted preoperatively and maintained in immediate postoperatively phase to decompress the bowel, promote intestinal rest, and prevent vomiting (Doenges, et al. , 2006). * Administered IV fluids (D5LR 1L x 8 or 30 gtts/min) and electrolytes (D5 Balanced Multiple Maintenance Solution w/ 5% dextrose 1L x 8 or 30 gtts/min). The peritoneum reacts to irritation/infection by producing large amounts of intestinal fluid, possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances (Doenges, et al. , 2006). * EvaluationShort Term Goal met. After 30 minutes of nursing intervention the patient was able to have a full understanding w ith regards to maintaining fluid balance as evidenced by verbalizing, So kaya pala hindi pa ako pwede kumain ngaun para maiwasan mairritate ang tiyan ko. Long Term Goal met. After 3 days of nursing intervention the patient was able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor (1-2 seconds), stable vital signs (please see page __ ), and adequate urine output of 620 mL with an appearance of amber yellow. Problem 4 RISK FOR INFECTION July 24, 2012 Subjective Cues Nurse, sobrang kailangan ba talaga ang paghuhugas ng kamay bago linisan o hawakan sugat niya? , asked by the mother. * Objective Cues * Post-operative condition presence of surgical incision * Surgical site is warm to touch and reddened * Temp 36. 3C * Nursing Diagnosis Risk for infection related to incompetent primary defenses secondary to post-operative surgical incision It is risk to be invaded by pathogens especially if surgical site is near at the perineal area, pathogens can also develop by poor personal hygiene and poor wound cleaning (Doenges, et al. 2006). * Goal/NOC Risk Control (For Infection) Outcomes Short Term After 30 minutes of nursing intervention the patient will be able to have partial understanding about infection control and will verbalize understanding of and willingness to follow up prescribed regimen. Long Term After 3 days ofnursing interventionthepatient will be free of sign and symptom r/t infection. * NIC Incision Site distribute Infection Control appal Care Independent * Monitored vital signs. Noted onset of fever, chills, diaphoresis, changes in mentation, and reports of increasing abdominal pain.Suggestive of presence of infection/developing sepsis, abscess, peritonitis (Doenges, et al. , 2006). * Inspected incision and dressings. Noted characteristics of drainage from wound/drains, presence of erythema. Provides for early detection of developing infected process, and/or monitors resolution of preexisting peritonitis (Do enges, et al. , 2006). * Instructed proper hand washing. estimable aseptic wound care. Reduces risk for infection (Doenges, et al. , 2006). * Encouraged adequate nutritional intake after the NPO status of the patient and when the patient is allowed to eat.Adequate intake of protein, Vitamin C and minerals is essential to promote tissue and wound healing (Sparks and Taylor, 2005). Dependent * Administered antibiotics (CEFUROXIME 750mg TID Q 8 x 2 doses & METRONIDAZOLE 500g/IV Q 8 x 2 doses) as ordered. Therapeutic antibiotics are given if the appendix is ruptured or abscessed or peritonitis has developed (Doenges, et al. , 2006). * Prepare for/assist with incision and drainage (I&D) if indicated. May be necessary to drain contents of localized abscess (Doenges, et al. , 2006). * Evaluation Short TermGoal met. After 30 minutes of nursing intervention the patient was able to have an understanding about infection control as evidenced by verbalizing, Para maiwasan ang pagkaroon ng impek syon kailangan kong maghugas ng kamay palagi at kinakailangan din ang araw-araw na paglilinis ng sugat ko kahit na sa tuwing nililinisan ito makirot sa pakiramdam. Long Term Goal met. After 3 days ofnursing interventionthepatient was free of sign and symptom r/t infection. Problem 5 INABILITY TO PERFORM ACTIVITY/IES OF DAILY LIVING (ADL) JULY 24, 2012 * Subjective Cues Hirap talaga ako gumalaw, maglakadlakad, o kahit man lang umupo dahil sa mga nakakabit na ito sa akin, as verbalized by the patient. Nakakapanghina pa kasi masakit nga yung tahi tapos madalas din nagcacramps ang tiyan ko, he added. * Objective Cues * Presence of surgical incision * Presence of contraptions (urinary catheter, NGT lavage & IV fluid left hand) * Nursing Diagnosis Impaired material mobility related to body weakness, presence of surgical incision, pain, & presence of contraptions attached physiologic immobility can be usually associated with post-operative conditions (Gulanick, et al. 1994). * Goal/NO C Activity Tolerance Outcomes Short Term After 30-45 minutes of nursing intervention the patient will be able to have a clear understanding with the use of identified techniques to enhance natural action tolerance and to apply it as well as evidenced by participating in fixed storage exercises, lower leg & mortise joint exercise, ambulation, or even moving up in bed. Long Term After 2-3 days of nursing intervention the patient will be able to continually participate in a simple form of activity and will report an onward motion with regards to his activities. * NIC Exercise Therapy BalanceIndependent * Performed passive ROM exercises. ROM exercises and good body mechanism strengthen abdominal muscles and flexors of spine (Gulanick, et al. , 1994). * Encouraged lower leg and ankle exercises. Evaluated for edema, erythema of lower extremities, and calf pain or tenderness. These exercises stimulate venous return, decrease venous stasis, and reduce risk of thrombus formation (Gulanic k, et al. , 1994). * Noted emotional and behavioural responses to immobility. Provided diversional activities. Forced immobility may heighten restlessness and irritability.The Cardiovascular SystemDiversional activity aids in refocusing attention and enhances coping with actual and perceived limitations (Gulanick, et al. , 1994). * Assisted with activity, progressive ambulation, and therapeutic exercises. Activity depends on individual situation. It should begin as early as possible and usually progresses slowly, based on client tolerance (Gulanick, et al. , 1994). * Assisted in moving from side to side or up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. Gulanick, et al. , 1994). * Noted client reports of weakness, fatigue, pain and difficulty accomplishing tasks. Symptoms may be result of/or contribute to intolerance of activity (Gulanick, et al. , 1994). Dependent * A dministered pain medication (TRAMADOL 50 mg/IV Q 8 x 3 doses, time given 8 AM) as prescribed and on a regular schedule. Clients anticipation of pain can increase muscle tension. Medications can help relax the client, enhance comfort, and improve motivating to increase activity (Gulanick, et al. , 1994). * Evaluation Short TermGoal partially met. After 30-45 minutes of nursing intervention the patient was able to have a clear understanding with the use of identified techniques to enhance activity tolerance and was able to use all of the techniques except for the ambulation. He refused to walk because he complained of pain whenever the catheter tube slipped into his legs. Long Term Goal partially met. After 2-3 days of nursing intervention the patient was able to continually participate in all of the identified techniques but still refused to participate in ambulation.He also reported of an improvement with regards to his activities as evidence by his verbalization, Medyo natotolerat e ko na rin yung mga activities kahit pautay-utay muna. Hindi ko lang talaga muna kaya maglakad pero pagnaalis na siguro yung catheter baka kayanin ko na. XV. BIBLIOGRAPHY * Cosgrove DO, Meire HB, Lim A, & Eckersley RJ. (2008). Grainger & Allisonns diagnostic Radiology A Textbook of Medical Imaging (5th edition). New York, NY Churchill Livingstone * Doenges M. , Moorhouse, M. Murr, A. (2006).Nursing Care Plans Guidelines for Individualizing Client Care across the Life Span (7th variate). F. A. Davis Company, Philadelphia * Doenges, M. , Moorhouse, M. Murr, A. (2006). Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th Edition). F. A. Davis Company, Philadelphia * Gabriely I, Leu, J. P. , Barky, N. (2008). Clinical problem-solving, back to basics. New England Journal of medicate * Gould, B. Dyer, R. (2011). Pathophysiology for the Health Professions (4th Edition). Saunders Elsevier Inc. * Gulanick, M. Klopp, A. , Galanes, S. , Gradishar, D. Puzas, M . (1994). Nursing Care Plans Nursing Diagnosis and Intervention (3rd Edition). Mosby-Year Book, Inc. * LeMone P. Burke, K. (2007). Principles of Medical-Surgical Nursing Critical Thinking in Client Care (4th Edition). Pearson world-wide Edition * LeMone P. Burke, K. (2008). Principles of Medical-Surgical Nursing Critical Thinking in Client Care (5th Edition). Pearson International Edition * Mosbys Pocket Dictionary of Medicine, Nursing confederative heath (4th Edition) 2002, Mosby Inc. Palma G. Oseda A. (2009). GA Notes Clinical Pocket Guide for Medical and Allied Health Professionals (2nd edition). GA Notes Publishing Co. , Philippines * Sabol, V. K. Carlson, K. K. (2007). Diarrhea Applying research to bedside practice. AACN forward-looking Critical Care * Tortora G. Derrickson B. (2006). Principles of Anatomy and Physiology 11th edition. Biological Sciences Textbooks, Inc. * Weber J. Kelley J. (2007). Health Assessment in Nursing (3rd Edition). Lippincott Williams Wilki ns
Sunday, February 24, 2019
When I face in front of the mirror, I tummy go steady a woman with short hair, round eyes, pale lips, and with an median(a) height, that is my body. When I do things alike brushing my teeth, eating dinner, walking, writing homework, sitting, and etc, which is what I am, I am a human because of what my body basis do. only who or what am I? As simply as it sounds, itll lay down time to internalize and answer this caput. People would start to think from the simplest to interlinking things and varying answers would come and go.Without looking in front of the mirror, without thinking the things that I can do, without thinking of what others might answer, but with my perception, experiences, and surroundings to answer the question Who or what am I? Well, I have answers. With my body as a basis, I know that I am Marjerie Valencia Hamili, 19 old age of age, residing at Sta. Maria, Zamboanga City since 1995, the seventh child, fourth daughter of my mother and father, studying at We stern Mindanao State University, taking up Bachelor of perception in Biology. With my answer above, it seems like there is something lacking like a missing puzzle piece.With my intimate relation of myself to my body, I have as well a spirit, which gives me the ability to control and claim my body in which Gabriel wave stated in his Second Reflection. With this body, I am able to move with other people like having new friends and sharing experiences together. I am in addition able to participate in the events that have been happening like family gatherings, celebrating holidays, and even supporting organizations. I am also able to see and appreciate Gods creation with my own two bare-assed eyes. With this body, I am able to express myself to the other people. I can say what I feel inside of me. I may also show it along with my gestures. With all the experiences of my body and my soul, it formed me to become the me of today.