Juvenile Justice- Juvenile Interviews-repost Assignment

Juvenile Justice- Juvenile Interviews-repost - Assignment Example ply means that juvenile offenders should be not except from being questioned, especially when there is a need to verify circumstances that led to the offense. As such, given the same prerogative of seeking the legal assistance of lawyers, the juveniles could wait for their appointed or assigned legal counsel before any statements are provided to the interviewing officer. Concurrently, in terms of determining who should be present during the interview, I also believe that the juvenile’s lawyer is of crucial importance, in addition to the interviewer. For some juveniles who have strong attachments to their parents, I also assert that if and when the juvenile asks for the presence of parents, the request could be granted. Parents have provided holistic support to their children in every aspect of their lives. As such, they could be sought to provide much needed support through their presence in this challenging situation. Of course, the parents’ presence would only mean th at the physical support is needed; and by no means should they attempt to interfere with the

A critical evaluation of affordable housing policy for the first time Essay

A critical evaluation of affordable housing policy for the first time buyer in leeds city centre - Essay Example staining a dualism in the housing market where renting, in its different guises, is relegated to a marginal position and tenants, unlike owners, are arguably cast as second-class citizens. However, past and recent research (e.g. Bramley & Watkins,P.23, 2004; Maclennan et al., P.104, 2002; Radley, P.45, 2004) has suggested that there are severe limits to the proportion of housing needs which can be realistically satisfied through owner occupation (even including low cost sales and Right to Buy). Action is therefore needed to provide greater term choice through the provision of more private and, especially, social rented housing to meet the needs of those unable to become homeowners. The British land-use planning process has changed very little since its constitutional beginning in the 1940s. Planning is primarily restricted to considering land-use issues through the management and coordination of policy at various levels of administration by a variety of agencies and actors. Implied to the operation of the land-use planning system is a national coordinating level, where the social, economic and environmental needs of spatial areas can be addressed in an integrated way. Although this suggests that planning can only be operated effectively when land-use issues are considered strategically (Bruton and Nicholson, P. 21-40, 2004; Rowan-Robinson et al., P, 369-381, 2004; Breheny, P. 233-249, 2002), the provision of a national element of strategic coordination by the central state is an essential ingredient in physical development. As Diamond (P18-25, 2004) has remarked, strategic planning sets out a frame of reference for the organisation of planning at the lower tie rs of administration. The planning process is managed and implemented by national and local tiers of government and is hierarchical in policy framework (Tewdwr-Jones, P. 584-593, 2005). Although there has never been a national physical plan in England, central government has always provided a clear approach

Case study analysis and an action plan Example | Topics and Well Written Essays - 1500 words

Analysis and an action plan - Case Study Example An action plan as well as a summary of findings will be provided in order to deliver a comprehensive understanding of the current scenario of Paul and the recommendations as suitable to his condition. As argued by many scholars, including Barker (2012), Mytton & et. al. (2012) and Gomez-Pinilla (2011) among others, unhealthy diet can impose strong negative affects to the health of the consumer causing various diseases such as blood pressure, abnormal sugar levels and heart diseases along with immunity related issues. Diet is an important contributor to maintain fitness of the body or health throughout one’s life. The first and foremost requirement of practicing a healthy diet is to have it on time and follow a firm routine for the meals in the entire day. As per the common belief and also based on proven facts, dietarians recommend that a healthy diet chart should have adequate proportion of liquids, fats and protein to help a body function properly and mitigate chances of health related issues to the highest possible extent. It is in this context that there are certain possible diet related risks, which might arise due to untimely dietary practices, such as observed in th e case of Paul. For instance, Paul was observed to avoid taking breakfasts on time, sufficing only with two cups of tea and that too with a heaped spoon of sugar. Even such practices obstructs proper digestive functions of the body and thereby increases risks of obesity and falling immune system that might also be witnessed in Paul (Geneva, 2003). Notably, with his growing age, Paul is quite certain to undergo immune system deficiency whereby he shall require special focus on his dietary practices and follow the same in routine gaps. Apparently, the dietary chart taken by Paul’s is not good for the development of his health. As can be witnessed from the assessment of his meal plan, Paul’s current dietary practices show imbalances in the

Online Rerservation System Essay Example for Free

Online Rerservation System Essay Online hotel or resort reservations are becoming a very popular method for booking hotel or resort rooms. Travelers can book rooms from home by using online security to protect their privacy and financial information and by using several online travel agents to compare prices and facilities at different hotels. 1 Hotel or resort reservations systems, commonly known as Online Reservation System (ORS) is a computerized system that stores and distributes information of a hotel, resort, or other lodging facilities. It is an assistant for hoteliers to manage all of their online marketing and sales, where they can upload their rates and availabilities to be seen by all sales channels that are using an ORS. Sales channels may include conventional travel agencies as well as online travel agencies. A hotelier using an online reservation system easens his or her tasks for online distribution, because an ORS does everything to distribute hotel information to the sales channels instead of the hoteliers.2 Here in the Philippines, the biggest hotels and resorts are using the same technology. But, in some far flung provinces, some hotels and resorts are still using manual reservation system. They use signages and some print advertisements for their marketing; and log books and some paperworks to record customers’ data. One of these establishments is the Double Mother’s Mayon Spring Resort which is located in Barangay Buyuan, Legazpi City. It was established by Lilian Pareja, a native of Albay Province, on March 8, 2008. She built the resort to fulfill her dreams of having one. Double Mother’s Mayon Sprong Resort has full amenities like: 15 rooms with toilet and bathrooms, all are airconditioned; 21 cottages; a convention hall for special occassions, and can accommodate up to250 persons;2 swimming pools; slides; restaurant with videoke; and a rent-a-car. The resort is one of the most affordable resorts in the province yet has a quaility of a five star place. The room price range from P 750.00 to P 5,000.00 per 24 hours of stay. The cottages are priced P 300.00 a day. And, the package program of their convention hall is P 25,000.00, with all the amenities included. The resort has varied of customers: from locals to foreigners. The main attractions of the resort are the full view of Mayon Volcano and the spring water coming from it. Tourists came in the province all year round. For 2 years that the resort was created, all transactions were made manually by the front desk personnel. After the reseachers meeting with the manager and talked about this study and its benefits to the resort, they immediately agreed as thevenue for the study. The resort understands â€Å"the role of information systems and technologies in company’s management and daily operations has been widely acknowledge and assessed as positive†.3 Research has shown the importance and unprecedented growth potential of e-commerce and its role as a new electronic distribution channel.4 It has been also well agreed in the literature that establishing an online presence and adopting e-commerce business models increases company’s competetiveness, profitability, and efficiency. Statement of the Problem The Double Mother’s Mayon Spring Resort has no online presence and computerized system for their establishment. All their marketing and transactions are made manually, and because of this, it costs them time, money, and lack of customers. The researchers will find ways to answer the following questions: 1. How to attract tourists from other provinces and countries? 2. How to launch a marketing campaign that is low in cost? 3. How to provide aswers to the questions of would-be-customers without lifting a phone or having a face-to-face contact? 4. How and where to keep files accurately and effeciently with confidentiality? 5. How to retreive files and print reports easily?  6. Will it be possible to easily monitor the sales on daily, weekly, or monthly basis? 7. How to compute the bill of the customers accurately? Objectives of the Study This study aims to solve the current problems of Double Mother’s Mayon Spring Resort when it comes to Marketing/Advertisement and Management system. The researchers aim to achieve objectives, such as: 1. To attract tourists from other provinces and countries by developing and launching a program or website for information and online presence. 2. To launch a low cost marketing and advertisement campaigns that reaches a wide audience by having an online information and connected with other websites and government agencies connected with hospitality industry. 3. To provide answers to would-be-touristsby having a detailed Frequently Asked Questions coulumn on the resort’s website. 4. To keep files secured, accurate, and efficient by developing a database with passwords that only the administration and owners knows. 5. To retreive files and reports easily and automatically. 6. To save money and time for efficient and accurate transactions. Scope and Delimitation The study will provide answers to the problems of Double Mother’s Mayon Spring Resort when it comes to marketing and effectively managing the business. This will limit the study on the online presence and reservation system. Significance of the Study This study is important to all stakeholders, to the business and to the hospitality industry. 1. The study will make the business of resort thrive for installation of new system and technologies for doing marketing and management. 2. It will be a great help for the employees of Double Mother’s Mayon Spring Resort because it will make their work easier and efficient. 3. There will be less paperwork and their will be less time consumed. 4. The management can manned their manpower to do other things rather than do the time consuming procedures of traditional marketing and reservation system. 5. Assessing the customer’s record will also be easier, faster, more precise and accurate. 6. It will also make the establishment more efficient in terms of providing faster and more efficient quality service. 7. The tourists will have an option of reserving a room or package with the resort’s online presence. 8. The would-be-customers can save time, energy, and money in looking for the right resort or service. 9. This will benefit students and future researchers to serve as reference in conducting researches of similar nature and topic. 10. This will also help the researchers to widen their knowledge and provide them personal experience as they make and work on this study.

A Case Study Of Anita Brown Nursing Essay

A Case Study Of Anita Brown Nursing Essay During the last 15 years there has been a substantial rise in the number of newly diagnosed patients with acute kidney injury especially whilst an inpatient Yaklin, 2011. This is despite every effort to prevent AKI in clinical practice (Venkataraman, 2008). Anita Brown is one such patient, having been diagnosed with AKI following routine surgery. AKI occurring after surgery is associated with a significant increase in patient morbidity and mortality (Chertow, Levy, Hammermeister, Grover, Daley, 1998; Praught Shlipak, 2005). Here I will discuss the nursing management of Anita Brown over a 48 hours period. I will start by exploring the pathophysiology of AKI and identifying the type of injury Anita has sustained. Thereafter, in order to formulate an optimised, tailored 48-hour care plan, I will describe two different but complimentary assessment methods to identify Anitas priorities of care, namely the ABCDE framework (Resuscitation Council, 2010) and the Roper, Logan and Tierney (1980) model of nursing. The nursing interventions subsequently proposed will be justified in relation to Anitas pathophysiology and will be supported by professional literature. Finally, the findings will be incorporated into a 48-hour care plan based on six of Roper et al.s activities of living (ALs) and a brief conclusion presented. Background Anita Brown is a 45-year old woman who has been diagnosed with AKI as a result of severe dehydration, following insufficient fluid administration during/after her cholecystectomy operation. Anita has been experiencing intractable vomiting despite receiving nil by mouth. She is borderline hypotensive, tachycardic and tacypnoeic and has been oliguric for 6 hours. Current management includes fluid replacement. Anitas pain is being controlled by a patient controlled analgesia (PCA) pump of morphine. Pathophysiology of Acute Renal Injury AKI is an extremely complicated disorder (Martini, Nath Bartholomew, 2011). The definition of AKI is a decline in the functions performed by the kidneys resulting in increased levels of serum creatinine and urea detectable in the blood (Dirkes, 2011). Indeed, the condition is most easily recognised by a rise in serum creatinine plus a decreasing urine volume, however, these symptoms are also accompanied by other physiological changes, as will be seen later (Guidelines and Audit Implementation Network [GAIN], 2010). There are three general categories of AKI (relative prevalence shown in parentheses): pre-renal (~55%), intrinsic (~30%) and post-renal (~15%) (Marieb, 2010). Pre-renal kidney injury is the most common form and is generally reversible when renal perfusion pressure is swiftly restored. It has a number of causes, the most common being intravascular volume depletion (haemorrhage, dehydration, burns, gastrointestinal losses) or decreased cardiac output (myocardial infarction or cardiac arrhythmias) (Cheung, Ponnusamy, Anderton, 2008), all leading to hypo-perfusion within the kidneys (Gotfried, Wiesen, Raina and Nally 2012). Drugs that are vasoactive can also cause pre-renal kidney injury (Barber Robertson, 2009), since intra-renal vasoconstriction can ultimately lead to hypo-perfusion (Murphy Byrne, 2010). Anitas surgery was complicated since the planned laparoscopic cholecystectomy had to proceed to an open cholecystectomy, thus she probably suffered considerable intra-operative fluid loss. If inadequate replacement ensued, the reduced blood flow within Anitas kidneys could have caused hypovolemic or cardiogenic shock (Garretson and Malber ti, 2007). Indeed, inadequate intravascular volume arising from significant fluid/blood loss is a common cause of hypovolemic shock (Hand 2001, Bench 2004). A further cause of AKI, intrinsic kidney injury, is associated with injuries that structurally harm vessels, the glomerulus, or kidney tubules (Ali Gray-Vickrey, 2011). Prolonged or severe pre-renal hypoperfusion may lead to such injury through ischaemia. Alternatively, infectious elements or pollutants are a further cause of such damage (Murphy Byrne, 2010). Notably, tubular cells within Anitas kidneys would have been severely damaged if blood flow had been reduced to 20% of normal (Cheung et al., 2008), although the actual extent of her injury is currently unknown. This type of injury is termed acute tubular necrosis (ATN), and is a common reason for AKI in hospitilised patients (Ali Gray-Vickrey, 2011). ATN is characterised by decreased consciousness, reduced urine output resulting from tubular damage, and nausea and vomiting. Like prerenal injury, ATN is often reversible, however, early intervention and distinguishing the mechanism of damage, whether prerenal or intrinsic, is vitally important to improve patient outcome (Gotfried et al. 2012). Other less common causes of intrinsic injury are acute interstitial nephritis (AIN) arising from allergic drug reactions or systemic disease, and contrast-induced nephropathy (CIN) arising from toxicity associated with radiological contrast media administration (Fry, Farrington, 2006; Hilton, 2011; Thomas, 2008). Risk factors for CIN in patents undergoing radio-contrast include age and pre-existing renal impairment plus simultaneous administration of metformin to treat diabetes (Porth, 2007). Consequently, diabetic patients with renal impairment and taking metformin (a drug which is 100% renally excreted), when undergoing radio contrast should be closely monitored, and medication stopped 48 hours before and after the procedure (Royal College of Radiologists, 2009). Finally, post-retinal kidney injury arises from urinary tract obstruction, the resultant back-pressure inhibiting glomerular filtration rate and causing ischemia (Leach, 2009; Hsu Symons, 2010). ABCDE Approach: Airway, Breathing, Circulation, Disability and Exposure Nurses play a vital role in effectively managing acute-care patients such as Anita, with timely intervention resulting in the prevention of life-threatening complications (Clarke Ketchell, 2011). The use of a systematic approach that identifies the priorities of care is essential (Thompson, 2008). Comprehensive Clinical Assessment Guidelines exist for AKI (Lewington Kanagasundaram, 2011), which emphasise that it is essential to consider the underlying cause of AKI since certain origins, such as AIN, would need specialised therapy. Initial clinical orientation requires nurses to ensure that necessary tests are performed and relevant assessment/monitoring is undertaken swiftly (Henneman, Gawlinski, Giuliano, 2012). Antia has already been diagnosed with AKI arising from insufficient fluid replacement during surgery, thus prerenal kidney injury has arisen from renal hypo-perfusion and ischemia, due to an inadequate intravascular volume. Although the extent of the damage remains to be seen, restoring intravascular volume is key to Anitas recovery. A useful approach in assessing and managing a patient who may deteriorate, such Anita, is the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach (Resuscitation Council, 2010). This would be highly useful for Anita, as it would break down the complex assessment procedure for AKI into a systematic process, whereby assessment and treatment algorithms would allow provision of a prioritised care plan. The ABCDE framework also serves as a valuable tool in identifying/eliminating critical conditions (Thim, Krarup, Grove, Rohde, Lofgren, 2012). Anitas assessment will now be considered under the five separate headings. Airway The patency of Anitas airway would be checked, to ensure there is no obstruction. Anita is overweight and upper airway obstruction through narrowing of the airways can occur in obese patients especially during sleep (sleep apnoea) (Hillman, Platt and Eastwood, 2003). If Anitas PCA is causing sedation, she will be drowsy. Consideration should thus be given to providing adequate pillows to ensure her posture and positioning on the bed would be conducive to a patent airway, similar to a head-tilt and chin-lift position (Thim et al, 2012). Frequent repositioning would also guard against pressure sores. Breathing Assessment of Anitas breathing involves respiration rate coupled with observations regarding whether her breathing is noisy, or laboured; movements of the thoracic wall and use of auxiliary muscles are clues to look for (Thim et al., 2012). Assessing Anitas risk of post-operative sleep apnea would mean observing her when sleeping, and noting if she snores or is apnoeic (Thim et al., 2012). To alleviate such symptoms correct positioning would be vital, indeed it is known that poor positioning of obese patients in bed may impede lung expansion (Moore, 2007). Breathing difficulties could require oxygen administration or in severe cases, assisted ventilation (Thim et al., 2012). Anitas is slightly tacypnoeic (respiration rate=22/min); this needs monitoring. Anita has endured severe dehydration and the underlying cause of the tacypnoea is probably related to the ensuing reduced circulating volume, which in turn causes a numbers of associated physiological changes including increased respi ration rate (Large, 2005); other vital signs are also affected, as seen below. Circulation Anita is borderline hypotensive (BP=105/60 mm/Hg) and slightly tachycardic (pulse=108 beats/minute). The severe dehydration Anita has suffered means her heart tries to compensate for the reduced volume by pumping harder (increase in cardiac output) and faster (increased heart rate) (Large, 2005). Concurrently, the low fluid volume leads to a fall in BP. Consequently AKI-related dehydration, has resulted in adverse outcomes including hypotension, tachycardia, and tacypnoeic; weak pulse and cold hands and feet are further signs to look out for (Large, 2005). Additionally, level of mental status, dry oral mucous membranes, sunken eyes and reduced capillary refill/skin (or tongue) turgor are all secondary markers of dehydration (Merck Manuals, 2012) whilst ankle and sacral oedema are signs of fluid overload. Capillary refill time involves pressing on the pad of the middle finger for five seconds then measuring the time for normal colour to return (Large, 2005). Skin turgor involves pinch ing a fold of skin and observing if it falls back to normal position immediately (Scales and Pilsworth, 2008). Rapid restoral of Anitas circulating volume is vital, with additionally the need for close and continuous monitoring of fluid levels (input vs output) and hemodynamics (Dirkes, 2011). Anita is nil by mouth and iv fluid input is being controlled at a rate of 1000mls dextrose/saline over 12 hours. Dextrose/saline is primarily used to replace water losses post-operatively. Normally fluid intake and loss are balanced (Scales and Pilsworth, 2008), yet Anita has been oliguric for 6 hours. Normal urine output is 1ml/kg body weight per hour, the minimum acceptable being 0.5ml/kg/hr (Scales and Pilsworth, 2008). Thus Anita should have a minimum output of 50ml per hour. Obviously Anita is still suffering a fluid deficit. The kidneys can normally concentrate or dilute urine in response to fluid changes. If Anitas kidneys are conserving water any urine excreted will be concentrated and dark (Scales and Pilsworth, 2008). The colour should be noted, in addition to the actual volume, on the fluid b alance chart. Accurate records are critical in assessing Anitas fluid balance. The level of iv fluid needed to restore Anitas fluid balance depends upon an accurate assessment of her volume status, based on the following equation: Fluid required = pre-existing deficit + normal maintenance + ongoing losses. Fluid replacement calculations are challenging since Anitas precise deficit is unknown, also her frequent vomiting represents a variable, on-going fluid loss, which must be estimated and added to her maintenance fluid intake. A patient with a pre-existing deficit normally received rapid fluid resuscitation comprised of an initial large volume (~250ml) of iv saline, repeated as necessary. According to the Merck Manuals (2012) patients with intravascular volume depletion without shock can receive infusion at a controlled rate, typically 500 ml/h. Anitas fluid resuscitation status should be urgently established since Anita appears to be receiving maintenance fluids rather than rescue therapy. During Anitas recovery phase her clinical response to iv fluids will guide the rate of fluid replacement, her vital signs and urine output should return to normal once normal hydration is achieved. A urine output of > 0.5 to 1 ml/kg/h is required (Scales and Pilsworth, 2008). But in addition to urine volume, monitoring electrolyte status is a further part of patient management in the recovery phase of AKI (UK Renal Association, 2011; Abdel-Kader and Palevsky, 2009). Urea, creatinine and sodium are elevated in volume-depleted individuals but to differing extents (Thomas, Tariq, Makhdomm, Haddad Moinuddin, 2003). A full blood count is a further useful piece of information (Lewington Kanagasundaram, 2011). Disability Anitas state of consciousness has been evaluated through the Glasgow Coma Scale and is currently 15, indicating she is fully conscious and in no danger of disability pertaining to consciousness (Gabbe, Cameron, Finch, 2003). Nevertheless, her mental alertness should continue to be monitored. Nurses need to ensure Anita can communicate adequately, especially since AKI can affect mental status because of hypernatremia, as a result of low fluid volume. This happened because the vascular space becomes hypertonic and results in extracellular migration of water away from brain cells, hence accounting for neurologic symptoms (Lee, 2010). Also, Anita may be drowsy due to the morphine. Any mental status deficit should improve when Anita responds to treatment and stops opiate analgesia. Anitas repeated vomiting is disabling and is contributing to dehydration and electrolyte imbalances (Golembiewski, Chernin, and Chopra 2005; Gan, 2006), and clearly requires immediate attention. The underlying cause must be determined if appropriate interventions are to be used. Vomiting is common following anaesthesia, but is also linked to opioid treatment and also hypotension. There are a large number of drugs available to treat post-operative and opiate induced vomiting (Stevenson, 2006), however, Anitas renal status means that administering antiemetic medications  may be unwise. Anita is self-administering morphine, therefore the frequency of her usage, her level of pain control and alertness all need monitoring. In addition to sometimes causing sedation, nausea and vomiting, morphine can produce hypotension and respiratory depression, and obese patients, such as Anita, are at higher risk of these side effects. Therefore the risk/benefit of continuing PCA with this drug over n urse-controlled analgesia should be established; if continued Anitas respiration rate should be frequently assessed and she should be monitored for signs of opiate toxicity. Exposure Anitas wound must be checked regularly to ensure it is clean and there are no signs of opening or infection, especially given the trauma of her vomiting. Surgical drains and urine drains likewise must be kept patent and clean; whilst regular temperature checks would monitor pyrexia. The results of Anitas initial ABCDE assessment can now be put in to perspective by identifying key information to help devise her care plan through application of a second nursing framework. The Roper, Logan and Tierney Model (1980) Nursing Model and Care Plan The Roper, Logan and Tierney model (1980) can be applied to the case of Anita Brown in order to devise a tailored care plan. This model takes a holistic approach and allows the impact of Anitas morbidities on her activities of living (ALs) to be considered. The model identifies twelve activities ALs namely eating and drinking, working and playing, sleeping, elimination, washing and dressing, communication, breathing, expressing sexuality held in relation to lifespan and the dependence/independence continuum. The framework is simplistic, yet provides a means to develop a logical and systematic care plan that is based on teamwork and mutual coordination (Murphy et al., 2000). It allows systematic collection of information from a patients biological, physiological, sociocultural, environmental, and politico-economic, perspective (Roper, Logan, Tierney, 2000). The model is especially applicable in patients requiring acute care such as Anita, helping to highlight the priorities of care t hat must be undertaken (Murphy et al., 2000). Once assessment is complete, a plan of care can be formulated which takes into account lifespan and level of dependence but may not necessarily cover all ALs (Beretta, 2003). Here I will consider six of the most pertinent ALs which are relevant for Anitas 48-hour care. I will highlight Anitas problems in relation to the AL and describe the necessary nursing interventions and their goals as part of a 48-hour nursing care plan. Safe Environment Anitas skin should be healthy and in tact: Check integrity of wound; Anitas retching could rupture her stitches. Also check for infection or swelling following surgery using aseptic techniques. Record temperature regularly to ensure Anita remains apyrexial. Anitas vital signs are out of range: Closely monitor haemodynamic status, urinalysis and fluid balance status; these should be returned to normal through appropriate interventions. Check peripheral insertion line is patent, the fluid is running fast enough and the fluid is provided as prescribed. Accurately recording input (and output: see below). Anitas is vomiting: Anitas vomiting will be distressing. Treat the underlying cause of the vomiting, and immediately adopt simple interventions to alleviate symptoms e.g. provide adequate bowls and tissues, open a window or provide a fan. Anitas oral health may be compromised since she is vomiting and receiving nil by mouth. Offer assistance with oral hygiene. Anita is self-administering morphine: The potential for unwanted opiate side effects warrants investigation regarding level of usage and pain control. Discuss this with Anita and switched to nurse controlled non-opiate analgesia is possible. Breathing Anita respiration should be 15-20/min: Anita is slightly tacypnoeic. Regularly monitor vital signs and observations post-operatively. Since Anita is overweight she may easily get out of breath during minor exertion so encourage her to ask for nursing assistance if she needs help. Communication Anita should be coherent and respond appropriately to questions: talk to Anita about how she is feeling and ensure her AKI, post-operative status and/or analgesia is not adversely affecting her mental abilities. Be aware of non-verbal transmission of information such as facial expression of pain/discomfort. Elimination Anitas urine must be properly collected: regularly check the urine drainage bag and tubing to ensure patency and cleanliness and to record output. Similarly, if there is a wound drain in place. Provide bedpan/commode: It is unlikely that Anita will need to open her bowels, however, she should be encouraged to seek assistance and request a bedpan/commode should she need one. Anitas privacy and dignity must be respected throughout. Sleeping Anita may be sleepy: Anita may be drowsy from the morphine and want to sleep a lot. She is overweight, which may make her more prone to post-operative sleep apnea. Observe her when sleeping for signs of snoring or apnoea. Anitas posture and positioning on the bed is important, especially since she is at higher risk of pressure sores. Nurses would need to ensure Anita is not slumped but positioned in a semi-upright position and frequent repositioned. Mobilisation Anita must regain mobility: Anita is relatively young, but overweight which would hamper her everyday mobility. She should by encouraged to mobilise if possible such as assistance to a sitting position in a chair; this would reduce chances of post-operative thombosis. All of these nursing actions have been formulated in a 48-hour care plan, a proposal for which is shown in the Appendix. Although relatively young, and presumably previous to surgery largely independent, Anita is currently considerably dependent on nursing staff for many ALs. This is reflected in her care plan. The ultimate aim of the Roper model is to achieve goals that promote independence in all ALs. Achieving this objective requires regular evaluation of Anitas plan, which in turn requires accurate baseline data against which improvement or deterioration in her progress can be measured. The plan can then be adjusted accordingly (Holland, 2003). Conclusion Anita Brown has suffered AKI probably due to insufficient fluid replacement inter/post operation. The resultant drop in circulating volume has manifested in a number of adverse physiologic and haemodynamic events. Anitas symptoms are consistent with pre-renal AKI (although ATN cannot be ruled out (Cheung et al., 2008) necessitating swift intervention. The pathophysiology of AKI reveals that it is a multifaceted condition requiring complex clinical assessment (Lewington Kanagasundaram, 2010). Here I have described a simplified, logical approach to Anitas care, through the application of two systematic methodologies. The approaches advocated ensured all relevant assessments were performed and that appropriate and effective interventions were employed in the formulation Anitas 48-hour care plan. The ABCDE mnemonic was used since it represents a strong clinical tool for rapid assessment and treatment of patients such as Anita requiring swift and effective interventions. Whilst the Roper , Logan and Tierney (1980) model provided a holistic approach to patient care since it allowed assessment of the patient as a whole (OConnor and Timmins, 2002), and has thus taken into account Anitas specific needs and preferences, whilst ensuring she is treated appropriately (Clarke Ketchell, 2011). Adhering to such tried and tested formulae allowed delivery of an optimised, tailored care plan, which will improve Anitas prognosis and enhance overall outcomes.

Lead :: essays research papers

Lead is a lustrous, silvery metal that tarnishes in the presence of air and becomes a dull bluish gray. Soft and flexible, it has a low melting point (327 Â °C). Its chemical symbol, Pb, is from plumbum, the Latin word for waterworks, because of lead's extensive use in ancient water pipes. Itsatomic number is 82; its atomic weight is 207.19. Lead and lead compounds can be highly toxic when eaten or inhaled. Although lead is absorbed very slowly into the body, its rate of excretion is even slower. Thus, with constant exposure, lead accumulates gradually in the body. It is absorbed by the red blood cells and circulated through the body where it becomes concentrated in the soft tissues, especially the liver and kidneys. Lead can cause damage in the central nervous system and apparently can damage the cells making up the blood-brain barrier that protects the brain from many harmful chemicals. Symptoms of lead poisoning include loss of appetite, weakness, anemia, vomiting, and convulsions, sometimes leading to permanent brain damage or death. Children who ingest chips of old, lead-containing paint or are exposed to dust from the deterioration of such paint may exhibit symptoms. Levels of environmental lead considered nontoxic may also be involved in increased hypertension in a significant number of persons, according to studies released in the mid-1980s. As a result, the U.S. Centers for Disease Control in recent years have been revising downward the levels of environmental lead that it would consider safe. At one time, lead poisoning was common among those who worked with lead, but such workplace hazards have been largely curtailed. Lead has been used by humans since ancient times. It was used in ancient Egypt in coins, weights, ornaments, utensils, ceramic glazes, and solder. Lead is mentioned in the Old Testament. The Romans conveyed drinking water in lead pipes, some of which are still in operation. Roman slaves extracted and prepared the lead, describes a disease among the slaves that was clearly lead poisoning. Because of their potential toxicity, lead water pipes are no longer being installed. The greatest single use of lead metal today is in the plates of storage batteries for automobiles. The protective oxidation layer formed by lead in contact with such substances as air, sulfuric acid, and fluorine makes it highly resistant to corrosion. For this reason, lead has been used to make drainage pipes and lead chambers in sulfuric acid factories. It is also used as a roofing material. The softness and malleability of lead make it useful for sheathing telephone and television cables. Lead is used in solder because of its low melting point. When combined with tin, lead forms solder

Explain Why Pope Urban Ll Called for a Crusade

In 1095, at the Council of Clermont, Pope Urban ll made a powerful and well planned speech. His message was clear and precise, ‘go to the holy land in Jerusalem and claim back what is rightfully yours or die trying, and in return remission of all your sins with the assurance of the imperishable glory of the kingdom of heaven’. He was addressing Christians from all over France calling for a ‘Crusade’ in the name of God and as many would argue, abusing his authority and status he received from the Catholic Church.What occurred during the First Crusade is well known to many, whereas the reason behind Pope Urban ll calling the Crusade is a highly debated and contradicting issue. One of the reasons which are occasionally cited for Urban’s calling of the First Crusade is the call of help which Alexins Comnenus had sent to Urban at the Council of Piacenza. This letter was sent in response to the loss of Byzantine land which had occurred after the battle of M anzikert in 1072.The letter When Urban received this letter it is debateable as to whether he was actually galvanised by the thought of helping Alexins or if his main motive was an attempt at ending the schism between the Catholic Church and the Greek Orthodox church in Constantinople. This is likely as it was one of the ideals of the papal reform movement which Urban belonged to, following in the footsteps of his predecessor, Gregory VII. By making out to help the Byzantine emperor in their time of need, Urban hoped to heal the schism.Another reason behind why Urban called for a Crusade is for religious purposes. He felt Christians in the East needed to be rescued from persecution and had ‘suffered mightily at the hands of the Turks’ and there men and children were being persecuted and there women raped , this was also backed up in Alexins letter to the Pope. Christians were supposedly suffering under Muslim rule after the Byzantine Empire was defeated by the Seljuk Tu rks who reverted to Islam, at the point when Islam was a religion quickly rising in power and dominance.Urban saw this violation of the Christian race as a great disrespect of Christianity and used it as a stimulus in his speech at the Council of Clermont which angered and therefore manipulated the Christian race into heading to the holy land for the First Crusade. Finally, an additional reason for Urban’s calling for a so called Crusade was that he felt ‘the lands of Christ needed to be reclaimed’ and in the control of Christianity not in the hands of ‘infidels’. Jerusalem is at the centre of the Christian faith and is the eligions birth place. It is the land in which Jesus was crucified and then, as Christians believe, bought back to life in a miracle event. Urban said in his speech, ‘wrest that land from the wicked race, that land which the scripture says floweth with milk and honey and was given by god to the children of Israel’. By these few words we can understand why Urban felt so strongly that it the land of Christians and why he ordered for it to be reclaimed, even if it mean death.At the time of Urban’s speech Jerusalam was under the rule of Muslim, who also have a strong attachment with the land as it is the place where the holy prophet descended to heaven. Urban however believed that it belonged to the Christians and therefore ordered it to be reclaimed in the ‘name of god’. Pope Urban ll called for a Crusade at the Council of Clermont to claim back what he believed rightfully belonged to the Christians and unite the Catholic and Greek Orthodox churches. Through the cover of Alexins plea for help Urban strengthened relations with the Byzantine Empire and called on a Crusade that was to claim thousands of lives.