Evaluation Of A Clinical Evaluation Essay - 2196 Words

With the continuous changes in healthcare, evaluation of students’ clinical knowledge and skills relies on the need for continuous evaluation. Evaluation is the process of using data to make judgements about students’ individual performance. Evaluation of clinical performance provides data from which educators use to judge the extent to which students have acquired specific learning outcomes (Billings Halstead, 2016). With the use of best practice evaluation methods, clinical performance can be evaluated to ensure quality patient care. Educators face a challenging task when providing evaluation that is fair and reasonable. Tasked with evaluating students in the clinical setting, educators can evaluate how students integrate theory and apply it to real-life situations. Observations of performance in the clinical setting should focus on the outcomes to be met and competencies to be developed (Oermann Gaberson, 2014). Developing a clinical evaluation tool to determine wh ether students can think critically, prioritize problems, and complete patient care procedures correctly is essential. There are a variety of evaluation methods to use in nursing education. Depending on the learning outcomes to be measured will determine which tool best evaluates the students’ performance. Clinical practice is an essential and highly significant component of nursing education. Education programs are obligated to respond to government requests for well-educated healthcare professionals.Show MoreRelatedEvaluation Of The Clinical Training763 Words   |  4 Pagesa. Beginning December 5, 2016, the clinical instructor will use both formative evaluation methods to assess the student’s progress towards achieving the course outcomes and expected behaviors each week (Billings Halstead, 2016). In addition, the clinical instructor will review the student’s self-evaluation plan upon completion of the clinical rotation (Billings Halstead, 2016). b. The clinical instructor will evaluate the student using electronic orders, medication profiles, and the five rightsRead MoreEvaluation Of A Clinical Skills Essay1417 Words   |  6 PagesThis essay will discuss a clinical skill in which I have become competent in practicing. I will use a reflective model to discuss how I have achieved the necessary level of competence in my nurse training programme. The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection incorporates the following: description, feelings, evaluation, analysis, conclusion and an action plan (Gibbs 1988). The model will be applied to the essay to facilitate critical thought,Read MoreEvaluation Of A Clinical Psychologist Essay2151 Words   |  9 PagesMany psychology majors have the notion that a clinical psychologist performs daily psychological evaluations in the luxury of their cozy office. Although this is the case for a clinical psychologist who have their own private pr actice, many clinicians will spend hours throughout the day conducting evaluations in different schools or prisons. It is important traveling psychologist are equipped with the materials necessary to performing several psychological assessments for any ages. The purpose ofRead MoreEvaluation Of A Clinical Trial Essay1602 Words   |  7 Pages1.3 Clinical Trials A clinical trial is a prospective study comparing the effect and value of an intervention(s) against a control in human beings (Friedman De Mets, 2010). It is an assured way of determining whether an intervention has the hypothesized effect since researchers have control of most of the cofounders involved in the studies. Each of the participants is followed onward in time from a defined point in time, which is the baseline for the study. Participants are randomly assignedRead MoreClinical Performance, Evaluation And Clinical Risk Essay1899 Words   |  8 Pagesobedience rate in six months. Which is targeted to raise the basic knowledge about HAIs and the process of using proper HH correct methods and procedure to reduce the HAIS by healthcare professionals. Relevance of Clinical Governance to your project Clinical performance, evaluation and clinical risk (Freeman et al. 2016). Evidence that the issue / problem is worth solving: This is an infection that patient receives through their progression of care in health care setting during the process of gettingRead MoreEvaluation Of A Clinical Supervision Project925 Words   |  4 PagesAfter completing my clinical supervision project, I can reflect on multiple things I have learned about myself as a supervisor, including my approach to clinical supervision, my conference skills, and my strengths and weaknesses. I now recognize more than ever that effective supervisors must consistently self-assess their practice and make adjustments as necessary for continuous improvement, just as effective teachers do. Throughout the clinical supervision process, it became apparent that IRead MoreClinical Procedures For Ocular Evaluation1426 Words   |  6 PagesClinical optometrists take on the task of routinely evaluating and dealing with patients on a daily basis while also attempting to maintain a healthy, successful business environment. The book Clinical Procedures for Ocular Evaluation describes how clinical optometrists maintain healthy relationships with patients and also detail different tests that are commonly implemented. These tests allow for doctors to determine a patient’s well-being and follow the necessary steps to improve the state of theirRead MoreEvaluation Of The Clinical Practice Guidelines2227 Words   |  9 Pages Appraisal of CPG The Clinical Practice Guidelines (CPG) is guidelines that are systematically developed and informed by the Agree II tool that evaluate the quality and development of the CPGs. (Ambulance Victoria, 2014). It is used to help and guide practitioners and patients to make decisions towards specific health issues and to implement an intervention to optimise safety and recovery. (Cecamore et al., 2011). Clinical practice variation refers to patients that are diagnosed with the same orRead MoreEvaluation Of A Patient Clinical Pathway3366 Words   |  14 PagesEVALUATION OF A PATIENT CLINICAL PATHWAY IN A CLINICAL PHYSIOLOGY DEPARTMENT INTRODUCTION Health-care professionals regularly request systematic evidence-based guidance to facilitate decision-making in the provision of clinical care. For this, adequate support from hospital management is needed to implement changes within sectors of the NHS. An approach to the provision of such guidance is the use of clinical pathways as an implementation tool. Clinical pathways are structured multidisciplinaryRead MoreEvaluation Of A Nurse For My Clinical Essay1388 Words   |  6 PagesThis week, I had the opportunity to be in the OR department for my clinical. I spent a whole day observing the operation processes and the procedure itself, at the same time, I was able to get the patient to the post-operative care before they are discharged or sent to another floor for further observation. I had an opportunity to observe four procedures. When I first arrived I was fortunate enough to meet with a nurse who let me in the OR, who happened to be the preoperative nurse that I will work

Understanding Creationism Or The Big Band - 972 Words

INTRODUCTION The essential questions every human being ask themselves at one point in their lives is â€Å"Who am I?†, â€Å"Where did I come from?† , and â€Å"What is my purpose here?† These questions drive all scientific, religious, and philosophical thought. The answers to these questions is how we inform our lives and the world we live in. All these disciplines help us in a consciousness find out who we are and our self awareness. All we know is that we begin with some level of consciousness and self awareness. Because of the we can formulate a few ideas that our observation, our belief system, our experiences, and our capacity to reason play a vital role in how we perceive what religion, philosophy and science actually mean to us. In the chapter I read it talks about how whether on to if we recognize creationism or the big band it still boils down to a common them. That if we ignore the mind, or spirituality we can conclude that the world we live in become limited in coming up with new creative ways of thinking and reasoning. This intern is the foundation of ignorance, it limits understanding, freedom, and the capacity to engage in the essential question of life. In the book the author talks about essentially how regions are a set of rules that come out of situations that are based on our intellectual, physical, and emotional human nature. Also that religion and how we interpret religion changes with society. The universal phenomenon of religion is that it gives an individual aShow MoreRelatedThe Creationism Question Essay1829 Words   |  8 PagesIn a historical context, creationism versus the theory of evolution has always been a hotly contested subject, one of the major breakthroughs being when Darwin publicized his theory of evolution. When Darwin published his theory of evolution in 1859, his book was considered a major technological breakthrough at that time. The seeming â€Å"proof† that a God didn’t exist create d a catalyst, where creationism was replaced with an almost atheism, because the existence of evolution counteracted society’sRead MoreCreation: Scientifically Proven? Essay1537 Words   |  7 Pageson discrimination as they both tie very well together. To set aside both differences and to seek the knowledge of a creator is the purpose of importance. Let us reason to our creator and help the mind seek the answers it ponders on when seeking understanding. Who is our creator and why are we made so specific in this random seeming universe? A question one many consider of which nature will answer with clues. We will use critical thinking and the will for knowledge to understand who created us. AlthoughRead MoreCreation vs. Evolution Essay2251 Words   |  10 Pagesit threatens the power of their God. In this paper, I will focus on one theory that has been in conflict with the church for the past hundred years. The theory of evolution. For the purpose of this paper, when referring to religions creationism, I mean the creationist beliefs held by Christians, Jews and Muslims. The reason I have chosen to be isolated to those three religions is because they share a common history, and being three of the worlds largest religions encompassesRead More Biblical Creationism versus Scientific Origin Essay example8399 Words   |  34 Pages Evolution: The change in life over long time scales by descent with modification through natural selection, except when used in astronomical context (where it refers to slow changes in stars and galaxies.) Creationism: Specifically, I use this to mean Christian young-earth creationism; the belief that Earth was created in 6 literal days as written in Genesis 1. Taxon: a division of life: kingdom, phylum, class, species, etc, or an example of such a division (Animals, Chordates, Mammals, HumansRead MoreTexas Textbook Controversy5455 Words   |  22 Pages or really anything whatsoever. They run in staggered elections that are frequently held in off years, when always-low Texas turnout is particularly abysmal. The advantage tends to go to candidates with passionate, if narrow, bands of supporters, particularly if those bands have rich backers. All of which—plus a natural supply of political eccentrics—helps explain how Texas once had a board member who believed that public schools are the tool of the devil. Texas originally acquired its power overRead MoreIndira Nooyi5487 Words   |  22 Pagesworld (2006, 2007 and 2008) by Fortune magazine. * Ranked 4th on Forbes list of the world s most powerful women overall, not just in business. * Highest ranking female executive of Indian descent. Supports *Capital punishment * Teaching of creationism Her deputies * CFO Richard Goodman. * PepsiCo International chief Michael White. * John Compton, PepsiCo in North America Her stunning talents Art of persuasion New Motto Performance With Purpose Achievement with JJ Close associationRead MoreHow to Write a Business Report Essay18530 Words   |  75 Pages347). Sometimes you need to lobby or attempt to inï ¬â€šuence members of your audience so that they will act on your recommendations. In other words, you have to write it, pitch it and sell it (lobbying will be considered later in this chapter). The big leap: writing essays and writing reports We will shortly examine different types of reports, but ï ¬ rst we will take a brief detour to consider some of the problems writers new to reports sometimes encounter. The report is a speciï ¬ c genre of writingRead MoreLogical Reasoning189930 Words   |  760 Pagesassassinated. Try to discipline yourself to read and answer these sample exercises before looking up the correct answer in the footnote below, and before reading on. You do not need to write out the answer. The exercises are designed to test your understanding of concepts in the material you have just read. If you can answer the Concept Checks, then you will be ready to tackle the more difficult Exercises at the end of each chapter. ────1 Lets continue with our introduction to the principles of

Proofreaders and Teachers Correction Marks

Negative Effects Of Bullying Essay - 1175 Words

Effects of Bullying In the 2014-2015 school years, 292,400 students reported being bullied out of a total of 763,000 students (Student Reports of Bullying: results From the 2015 School Crime Supplement to the National Crime Victimization Survey, National Center for Education statistics(NCES)). Bullying does not affect only children in school, but can also happen to adults. Bullying has an immense effect on people of all ages. Whether it is an adolescent at school, or an adult in their workplace environment, some form of bullying may be present. There are many types and forms of bullying, such as, physical, verbal, and cyber, which is over the internet. Not only can bullying affect a person’s physical appearance, but some forms of†¦show more content†¦Daniel Fitzpatrick, thirteen-year-old boy, commits suicide in the attic of his home in West Brighton, Staten Island. Daniel did not leave this world silently; he left a letter of his extremely devastating journey with bul lying, behind. At first, it was a â€Å"great life† for this young, teen boy, but soon plunged into something much worse. Daniel Fitzpatrick was being bullied by five of his school-classmates. According to his letter, Fitzpatrick â€Å"begged and pleaded† with his teachers to help him, but â€Å"they did not do ANYTHING†. A month later, Daniel’s seventeen-year-old sister found him with a belt around his neck (Seamons, Kate, Boy, 13, Commits Suicide, Leaves behind Letter on Bullying, NEWSER). Bullying and suicide have become major concerns for public school officials’. The mass media and the professional literature have contributed to not only these separate concerns, but their critical connection, often evoking the specter of liability. For example, Essex started his article with a litany of television and newspaper reports of students who committed suicide in the wake of being bullied; - proceeded to cite scholarly recognition that â€Å"depressi on and suicide are foreseeable consequences of a school district’s failure to constrain a known bully from victimizing other students; â€Å"and suggested both federal and state avenues for successfully suing school officials in such circumstances (Zirkel, 633). Not only does bullying that leads toShow MoreRelatedNegative Effects Of Bullying Essay928 Words   |  4 Pages What are the effects of bullying on international students- A literature review Introduction Bullying has been a great problem in every workplace over several years (Bauman, Rigby Hoppa, 2008; Smith Brain, 2000; Olweus, 1994). Researchers have shown interest in this topic consistently (Policy, 2014; Sampson, 2009; Einarsen, Hoel Cooper, 2003). This literature review will cover the various definitions of bullying, bullying and emotional abuse in the workplace and school, various possible outcomesRead MoreEssay on Bullying and Its Negative Effects2940 Words   |  12 Pagesare abused by their parents, peers or even by complete strangers. One of these types of abuse is bullying. At a first glance, we might think that it is an older kid beating/teasing a younger classmate however; bullying consists of much more than this. The basic definition of bullying is when your behavior hurts or harms another person physically or emotionally. There are many different types of bullying, which may lead to a victim becoming violent later on. There is teasing and name calling, thereRead M oreBullying Essay631 Words   |  3 PagesDiana Vanessa Alba Writing Level 5 Cause and Effect Essay BULLYING IS TAKING OUR CHILDREN LIVES Have you ever bullied or been bullied? Bullying behavior can occur for many reasons, some of which are TV violence, families in poverty, mis-teachings, lack of parent’s attention and also kids under bad influence. Teens often begin bullying because they want to control those who are weaker than they are. Bullying gives you people an identity, they become well known in school, they want to be popularRead MoreHow Social Media Improved Communication? Essay876 Words   |  4 Pagesand young adults, and that it negatively effects their brains, character, or personalities, while most people see that the social media has a more positive effect on them than a negative one. Moreover, social media has helped many people around the world to connect, or re-connect, with each other, easily. Social media is basically the new way of keeping in touch with everything and everyone, and of even strengthening bonds between each other. This essay will argue that social media has improvedRead MoreThe Concept Of Self Concept1123 Words   |  5 Pagesor their self-esteem. Most of us correlate negative self-concepts, or low self-esteem, with learning difficulties and social reclusion. Recent psychological research has also discovered that inflated self-concept is correlated to violence, including bullying and even criminal acts. While reminiscent of the neo-Freudian Narcissistic Personality Indicator, Carl Rogers’ phenomenological theory is a better explanation of the apparent drive towards bullying and positive self-concepts. Rogers defines self-conceptRead MoreBullying And The Act Of Bullying Essay1660 Words   |  7 Pages----------- One may assume bullying in schools was all too common. And of course, in the end, they would absolutely right. For whether one has been the victim of bullying or, perhaps, a perpetrator of it, themselves, one has no doubt been exposed to stories of bullies through friends and family, as much as through movies and media. Indeed, it seems like bullying itself is a theme inseperable theme from one’s childhood or adolescent experience inc school. Whether was the victim of it or not, theyRead MoreBullying And Its Effects On Society1313 Words   |  6 PagesBullying is defined as a use of superior strength or influence to intimidate someone, typically to force him or her to do what one wants. The bully and those who are bullied can be of any age; bullying does not discriminate. There are a number of psychological causes and effects that can cause bullying and also the lasting effects of. However, in order to understand the psychology behind bullying, one must understand the rea sons that influence one to become a bully and the effects it can have onRead MoreBullying Is A Common Problem881 Words   |  4 Pages Bullying is a common problem. Bullying is very negative and creates bigger problems for society. Since many people don`t take bullying serious, they are often left shocked and confused when an incident occurs as a result of bullying. This essay is about dealing with bullying and one teens desparate struggle to deal with the issue; which ultimately led to her suicide at the age of 15. There are many forms of bullying. Two types of bullying that Amanda experienced was emotional bullying, which includesRead MoreEssay on Bullying In America989 Words   |  4 PagesBullying is an act that is an everyday occurrence in some people’s lives. Bullying can be direct or indirect. What this means, is that bullying can be in the form of violence such as hitting and kicking or in the form of verbal abuse such as name calling and teasing. Manipulation and exclusion are also forms of bullying. Bullying can be taken into consideration as a minor assault but any form should be taken seriously. Whether it is taken to an extreme, done over a long or short period of time, orRead MoreThe Effects Of Workplace On Health And Wellbeing Of Their Employees1508 Words   |  7 Pagesorganisations to protect the health and wellbeing of their employees. Workplace bullying includes verbal, physical, psychological or social abuse by an employer or colleague at work. Rousseau et al (2015, p.287) define workplace bullying as ‘repeated occurrences of negative acts over a sustained duration’ in which victims are unable to defend themselves. Furthermore, Randall (cited in Olive and Cangemi, 2015, p.20) defines workplace bullying as ‘aggressive behaviours that are intended to inflict psychological

The Role Of Women In The Things They Carried - 1203 Words

The Things They Carried by Tim O’Brien is a collection of multiple short stories about Tim O’Brien’s, recollections of his time as a soldier in the Vietnam War. This novel depicts the experiences and effects of the Vietnam war on the lives of the American soldiers. O’Brien informs the readers that the stories may not be completely true or moral but that’s the point of a true war story. In the novel, O’Brien introduces characters by the items they carried. The thoughts of women or items women had given to these men were often recognized in the book. O’Brien incorporated a few female characters such as Martha, Mary Anne Bell, and Henry Dobbins’s girlfriend in order to show the influence they all had on the men in the novel. Though the†¦show more content†¦He destroys his connections to the past and becomes focused on the present. He gives up all that had and would distract him from war. He burns the letters and photos th at was given to him by Martha. Another character who used fantasies of women as a mental escape from the war happening around them was Henry Dobbins. Dobbins carried his girlfriend pantyhose. He would wrap his girlfriend pantyhose around his neck before heading into ambush. He liked â€Å"putting his nose into the nylon and breathing in the scent of his girlfriend’s body; he liked the memories this inspired; he sometimes slept with the stockings up against his face, the way an infant sleeps with a flannel blanket, secure and peaceful† (111). The pantyhose symbolized home, faith, and hope. The stockings allowed Dobbins to recall memories of more pleasant times when he was with his girlfriend, away from the war. The story of Mary Anne Bell also portrayed how women were used in coping with the war. Mary Anne was the girlfriend of the soldier Mark Fossie. Mark Fossie was assigned to a location in Vietnam that lacked supervision, which allowed the soldiers to have a small sense of freedom they felt they had back home. Fossie invites his girlfriend, Mary Anne, over to Vietnam because he believed and thought she was going to make being in the war better for him. Women also symbolized how man can be changed by the war. The story of Mary Anne Bell is fitting for thisShow MoreRelatedThe Role of Women in The Things They Carried Essay1361 Words   |  6 Pageswars. Pure garbage. You got to get rid of that sexist attitude. The role of women in the book The Things They Carried is an important one. These men have various views and feeling about the women they love, the women they hate, and the women that they may not know and can only dream of. While the text given to the ideas of women is small is stature, it is quite significant in meaning. There are three main women that enter and disrupt the lives of the Alpha company; Mary-Ann, Martha, andRead MoreWomen Roles in The Things They Carried Essay952 Words   |  4 PagesIn this book there are three major women Linda, Martha, and Mary Anne. Lindas role is positive yet very saddening because she in a way has given Tim OBrien the power to tell stories so in depth using memories. Mary Annes role is encouraging because she comes to Vietnam and throughout the journey she discovers herself; she redefines the typical role of women. Marthas role in this book could be considered positive because she is keeping up Jimmy Crosss morale but, at the same time it c ould beRead MoreWomen and Their Role in The Things They Carried by Tim Obrien888 Words   |  4 PagesThe Things They Carried Women and their Role in The Things They Carried Within the book The Thing’s They Carried, the stories of the male soldiers and their dealings with the Vietnam War. However he also delves into the stories of the women and how they affected the soldiers and their experiences in Vietnam. While the men dealt with the horrors of war, the women were right at their side, just not in as much of a public view as the male soldiers. O’Brien uses women such as Martha, Linda and KathleenRead MoreWomen Roles In The Things They Carried by Tim OBrien Essay927 Words   |  4 PagesIn this book there are three major women Linda, Martha, and Mary Anne. Lindas role is positive yet very saddening because she in a way has given Tim OBrien the power to tell stories so in depth using memories. Mary Annes role is encouraging because she comes to Vietnam and throughout the journey she discovers herself; she redefines the typical role of women. Marthas role in this book could be considered positive because she is keeping up Jimmy Crosss mora le but, at the same time it could beRead MoreFake Love in The Things They Carried by Tim O ´Brian Essay518 Words   |  3 Pagesexample, feels bereft after the war because his hope for happiness in Martha is dashed by her rejection.† (Loneliness and Isolation.) While reading the book The Things They Carried by Tim OBrian, a reader can easily come across many items that represent certain things for the carrier. All these items are symbols for those men and women. For Example, Lieutenant Jimmy Cross â€Å"humps† --a word OBrian used at the beginning of the book to open this point-- his love for a woman named Martha and the dangerRead MoreThe Outlander, By Gil Adamson1619 Words   |  7 PagesMary’s Character in The Outlander, and Gender Roles in the Early 1900s â€Å"Let women be what God intended, a helpmate for man, but with totally different duties and vocations†. In 1870, those words were said by Queen Victoria. By the early 1900s, what she said was still ringing in the ears of the people, even in Canada, which was a considerably young country at this time (History Learning Site). The Outlander, written by Gil Adamson, takes place in Canada during 1903. The story is about a mad youngRead MoreThe Things They Carried By Tim O Brien Essay832 Words   |  4 PagesSummary: â€Å"By and large they carried these things inside, maintaining the masks of composure† (21). In Tim O’brien’s The Things They Carried, the American soldiers of the Vietnam War carry much more than the weight of their equipment, much more than souvenirs or good-luck charms or letters from home. They carried within themselves the intransitive burdens—of fear, of cowardice, of love, of loneliness, of anger, of confusion. Most of all, they carry the truth of what happened to them in the war—aRead MoreThe Things They Carried By Tim O Brien1242 Words   |  5 Pages12) Tim O’s text, The Things they Carried, details his uses of word choice to portray his tone and bias. Tim O’Brien uses Martha to represents the idea of home and all it attendant images. He also uses letters and quotes to convey his image. Despite the fact that women assume a little part in The Things They Carried, it is a critical one. The Female characters Martha, Mary Ann e Bell, and Kathleen Cross all affect the lives of the soldiers . Tim O’Brien uses the female role to portray his view andRead MoreAssess the usefulness of functionalist theories in understanding religion today965 Words   |  4 Pagesthere are four main ways in which religion maintains value consensus. One way is through the sacred and profane, he argued that sacred referred to things that are separate from society and create feelings of awe, wonder and fear whereas profane referred to things that were inferior with no real significance. Durkheim therefore argued that the only thing powerful enough to inspire people in the way religion does is society itself therefore meaning people are not worshipping their religion or god, butRead MoreThe Things They Carried by Tim O ´brien Essay example642 Words   |  3 PagesIn the book â€Å"The Things They Carried† four female characters played an important role in the lives of the men. Whether imaginary or not, they showed the power that women could have over men. Though its unknown if the stories of these women are true or not, they still make an impact on the lives of the soldiers and the main narrator. Martha, even though she is only ever mentioned in the beginning of the book, still plays a huge role in the lives of the soldiers. In some ways, she is a large part

Critical Care Nursing-Cushing’s Syndrome-Susan Summers Case Study

Question: Discuss about the Critical Care Nursing-Cushings Syndrome-Susan Summers Case Study. Answer: This essay focuses on Susan Summers, a female client aged 40 years with three children all aged below ten years. She works in a supermarket as a casual at night. She takes wine in order to adapt to her. She had been diagnosed with type 2 diabetes and obesity with 90kg which corresponds to a Body Mass Index of 35kg/m. She was admitted for laparoscopic right adrenalectomy following noticeable changes in her general appearance because of Cushings syndrome which resulted from a benign tumor on the right adrenal gland. Cushings syndrome is a medical condition associated with excessive levels of cortisol hormone. Susan had to undergo right adrenalectomy under general anesthesia. Adrenalectomy refers to the surgical removal of the adrenal grand. Susan stayed in the Post-anesthetic recovery room (PARU) for two hours and then taken to the ward. She had an indwelling Urinary Catheter and a record of observations. The essay will focus on causes and pathophysiology of Cushings syndrome. It will also discuss the pathophysiology behind the deterioration of Susans condition post operation and the appropriatenursing interventions. Lastly, the essay will touch on some of the members of the interdisciplinary health care team. Cushings syndrome is associated with prolonged or excessive exposure of body tissues to excessive levels of cortisol hormone which is produced by the adrenal glands. Adrenal gland also produce other hormones such as epinephrine, dehydroepiandrosterone and norepinephrine. Cortisol hormone is responsible for regulation of blood pressure, counteraction of allergies and inflammation, maintaining stress resistance and normal functioning of the cardiovascular system. A tumor on the adrenal gland may lead to excessive production of cortisol hormone. It can also result from excessive use of corticosteroids such as prednisone (Nieman et al, 2015 High levels of cortisol hormone are associated with factors such as stress, alcoholism, malnutrition, depression and emotional stress. A tumor on the pituitary gland may lead to excessive release of adrenocorticotropic hormone (ACTH) which consequently leads to increased release of cortisol from the adrenal gland cortex. A primary disease of the adrenal gland can also lead to excessive production of cortisol leading to Cushings syndrome. Heredity is also a contributing factor to Cushings syndrome but rarely. High levels of cortisol leads to hypertension, hyperglycemia, insulin resistance, obesity, weight gain, type 2 diabetes and fat deposition on the neck, face and belly (Craft et al, 2015). After making a diagnosing Cushings syndrome, Susan had to go for laparoscopic adrenalectomy of the right adrenal gland based on her clinical presentation, location and size of the tumor (Maestre-Maderuelo et al, 2013). After operation, Susan was taken to post-anesthetic recovery unit (PARU) for recovery from the general anesthesia. At post anesthetic recovery unit (PARU) she was put under close monitoring for any signs of deterioration and complications. She was later taken to the ward for management as she awaited discharge after two days. Her observations in the ward include: Blood pressure-160/90mmHg, Temperature-35.0c, respirations-30breaths per minute, pain score-0/10, pulse-128beats per minute and an Indwelling Urinary Catheter indicating 5mls of urine for 1hour (Maestre-Maderuelo et al, 2013). Operation under general anesthesia could have led to hypothermia temperature of 35.0c compared to normal of (36.5-37.0c). During general anesthesia, the normal mechanisms of thermoregulation in the body are inhibited leading to low body temperature (Aksu et al, 2014). Postoperative hypothermia is also associated with female gender, old age, emergency surgery and amount of blood loss during the surgical procedure. Prolonged anesthetic period or surgery, technique used in anesthesia and room temperature can also lead to hypothermia. Postoperative hypothermia can lead to infection of the surgical site, blood transfusions, discomfort, pressure sores and mortality (Aksu et al, 2014). A pulse rate of more than 100 beats per minute is termed as tachycardia. Excessive alcohol consumption, obesity, Cushings syndrome and hypertension are associated with tachycardia. Alcohol leads to increased fats in the blood stream which can clog the blood vessels. This leads to increased peripheral resistance and increased pressure exerted on the walls of the blood vessels .Increased peripheral resistance leads to a consequential increase in blood pressure. Alcohol also causes thickening and narrowing of blood vessels, which makes the heart to strain as it tries to compensate for the disorientation in its normal functioning. This results to increased heart rate of 128 beats per minutes and high blood pressure (160/90mmHg). Obesity is a risk factor for hypertension. Obesity is associated with increased intravascular volume which leads to increased cardiac output (Lacroix et al, 2015) Based on a normal respiration rate of 12-20 breaths/minute, Susan had tachypnea with a respiration rate of 30 breaths per minute. Some of the factors which could have led to tachypnea are hypertension, fluid loss and damage of the heart as a result of alcohol. Bleeding during operation or post-operation could be another possible cause of increased rate of respiration and tachycardia to Susan. The normal urine output is more than about 20 mls/hr/kg in an adult which indicates sufficient renal perfusion and functioning (Harding, 2017) Susans incidence of 5mls of urine in hour can be termed as oliguria. Oliguria refers to a urine output less than 20ml/kh/hour in an adult. Postoperatively, decreased urinary output results from blood or fluid loss due to decreased rate of glomerular filtration secondary to hypotension and hypovolemia. Reduced tissue and organ perfusion can also lead to reduced kidney functioning resulting to reduced urine production. It can also be due to adrenal cortex response to stress due to increased release of aldosterone and antidiuretic hormone. The general anesthesia used during the surgery and stress associated with surgery could also be other causes of reduced urinary output post operation. Anesthesia influences the sympathetic activities, hemodynamics and humoral regulation. Opioids, benzodiazepines and barbiturates cause a reduction in the rate of glomerular filtration leading to reduced urinary output. Medications and medical conditions can disorient kidney perfusion and functioning lea ding to abnormalities in the amount of urine output (Harding, 2017) For better postoperative outcome and good prognosis of Susans condition, appropriatenursing interventions were required. Appropriate and qualitynursing management is important to promote patient recovery and prevent deterioration of the patients health condition due to complications associated with poor nursing management. ISBAR (Identify, Situation, Background, Assessment and Recommendation) tool can be used to promote improvement of safety when transferring critical patient information from one department to another in health care system, for instance from theatre to PARU then to the ward (Morton et al, 2017 The key priorities of Susan are stabilization of vitals, fluid and electrolyte balance and prevention of deterioration and complications. On arriving in the ward, the ABCDE approach is important in a clinical emergency for fast assessment of the patients condition and immediate initiation of treatment (Estes et al, 2016). This approach aims at providing life-saving management, breaking down complex medical situations to manageable portions and establishing common awareness of the situation among all health care providers. To implement on this approach, it is recommended to check for patency of the airway. Airway can be partially or completely blocked by foreign objects, secretions or inflammation which can lead to breathing difficulties to the patient. On breathing, one should ensure that the patient is breathing sufficiently. Insufficient breathing is manifested through cyanosis, tracheal lateralization and distension of neck veins (Morton et al, 2017 Sufficient circulation should be assessed to ascertain any abnormalities such as variations in pulse rate, sweating, color changes and decreased consciousness level. Assessment of disabilities gives more information on the level of consciousness of the patient. Consciousness can be assessed using tools such as AVPU (Alert, Voice responsive, Pain Responsive and Unresponsive) and Glasgow Coma Scale. Exposure aspect of the ABCDE approach gives the general condition of the patient which includes signs of bleeding, trauma and skin reactions such as rashes (Brown et al, 2017). The elevated blood pressure of 160/90mmHg and tachycardia (128beats per minute) can be managed through close cardiovascular observation. This can be implemented by accurately and continuously measuring and monitoring pulse and blood pressure in order to detect any signs of improvement or deterioration. Postoperatively, most patients are at high risk of fluid and electrolyte imbalance because of fluid or blood loss, starvation and exposure during surgical operation (Brown et al, 2017). Low amount of urine output (5mls of urine in hour) is an indication of fluid volume deficit. In this instance, administering intravenous fluids following prescriptions is an important nursing intervention. Secondly, it is important to closely monitor the input/output using charts to ascertain any kidney dysfunctions. It is important to encourage the patient to avoid movements which are precipitating factors of hypertension and tachycardia. For the postoperative hypothermia characterized by a temperature of 35.5 centigrade, it is important to monitor temperature variations and keep the patient warm using synthetic blankets. Since Susan has an indwelling catheter, catheter care is very important to prevent infections (Brown et al, 2017). A multidisciplinary health care team is important during the care of Susan and her life after she has been discharged from the hospital. Susan is a single parent with three children whom she raises alone from her job as a casual worker. Recommending her to a social worker would be important. It is recommendable if she is given a leave of two months from work for her recovery. A counselor would be important to guide her on how to handle her family and work without having to take alcohol in order to cope with her life (Momsen et al, 2012 A diabetes health educator could also be recommended for her since she has type 2 diabetes. The educator can provide more information about diabetes, its risk factors, causes and lifestyle modifications important for prevention of diabetes. An IDEAL discharge plan should be applied since it incorporates the patient and her family to prevent complications and deterioration after discharge hence promoting patient satisfaction. Objectives of the discharge include prevention of complexities and promote healing (Momsen et al, (2012 In conclusion, the underlying etiology and pathophysiology of Cushings syndrome were highlighted and explained. Base on the case study of Susan, the essay has captured the presenting medical condition, its causes, pathophysiology, manifestations and nursing management interventions. Nursing interventions have been based on the patients health care priorities. The essay has also addressed the importance of the multidisciplinary health care team counsellor, social worker and a health educator in care of the patient. References Aksu, C., Ku?, A., Grkan, Y., Solak, M., Toker, K. (2014). Survey on postoperative hypothermia incidence in operating theatres of Kocaeli University.Turkish journal of anaesthesiology and reanimation,42(2), 66. Brown, D., Edwards, H., Seaton, L., Buckley, T. (2017).Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences. Chatterjee, S., Khunti, K., Davies, M. J. (2017). Type 2 diabetes.The Lancet,389(10085), 2239-2251. Craft, J., Gordon, C., Huether, S., McCance, K., Brashers, V., Rote, N. (2015). Understanding pathophysiology (2nd ed.). Daniel, E., Newell-Price, J. D. (2015). Diagnosis of Cushings disease.Pituitary,18(2), 206-210 Estes, M., Calleja, P., Theobald, K., Harvey, T. (2016). Health assessment and physical examination. (Australian and New Zealand 2nd ed.) Melbourne: Cengage Learning. Harding, M. M. (2017). Fluid, electrolyte and acid-base imbalances. In Lewis, S. L. (10th ed.). Lewis's Medical-Surgical Nursing (pp. 270-299 ). Elsevier. Huether, S., McCance, K. (2017). Understanding pathophysiology (Sixth ed.). Lacroix, A., Feelders, R. A., Stratakis, C. A., Nieman, L. K. (2015). Cushing's syndrome.The lancet,386(9996), 913-927. Lus, C., Moreno, C., Silva, A., Pscoa, R., Abelha, F. (2012). Inadvertent postoperative hypothermia at post-anesthesia care unit: incidence, predictors and outcome.Open J Anesthesiol,2(5), 205-13. Maestre-Maderuelo, M., Candel-Arenas, M., Terol-Garaulet, E., Gonzlez-Valverde, F. M., Marn-Blzquez, A. A. (2013). Laparoscopic adrenalectomy: the best surgical option.Cir Cir,81(3), 196-201. Momsen, A. M., Rasmussen, J. O., Nielsen, C. V., Iversen, M. D., Lund, H. (2012). Multidisciplinary team care in rehabilitation: an overview of reviews.Journal of rehabilitation medicine,44(11), 901-912. Morton, P. G., Fontaine, D., Hudak, C. M., Gallo, B. M. (2017).Critical care nursing: a holistic approach(p. 1056). Lippincott Williams Wilkins. Nieman, L. K., Biller, B. M., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., Tabarin, A. (2015). Treatment of Cushing's syndrome: an endocrine society clinical practice guideline.The Journal of Clinical Endocrinology Metabolism,100(8), 2807-2831.

Araby The Maturity Of A Boy Essay Example For Students

Araby: The Maturity Of A Boy Essay The Maturity of a Boy Passion, adolescence, foolishness, and maturity are the first words that come to ones mind to describe James Joyces short story, Araby. In it, he writes about a boy who falls deeply in love with his best friends sister, who through the story, doesnt seem to notice him or care about him. The boy, who has yet to be named, lives in a poor and run-down town. During the story, certain characters contribute to the boys developing sense of maturity, and eventually, lead him into adulthood. Mangans sister, the boys uncle, the priest, and the girl at the bazaar all serve the purpose of molding the boy into a mature person. Undoubtedly the main person who unknowingly helps the boy along the path of maturity is Mangans sister. She is the boys crush. Whenever he sees her, he follows her wherever she goes. This is strange because the boy admits to hardly ever speaking to her, and he does not know her name. He even pulls up the blinds so that he can watch her. These points show the boys immaturity, but such can be expected from a boy his age. He thinks about Mangans sister and visualizes her image everywhere he goes. He idolizes her as an angel. She seems to become a symbol of what he is living for, and she gives meaning to his life. He shows that he is truly in love with her when he starts to talk with her and forgets what he says, which is because he is so caught up in the moment talking with her to think about what he is trying to say. The phrase She asked me was I going to Araby. I forgot whether I answered yes or no. , best exemplifies these ideas. His immaturity shows in these scenes, but in the end, he finally realizes how immature he really has been by following this girl around. By saying that, we find out that the boy does not just realize his immaturity right away, it takes him a while to mature enough to figure this fact out on his own, and therefore, Mangans sister plays a major role in the development of the boy. Aside from the girl, there were also other people with a major impact on the boys maturing process. Another one of the characters who aided the boy in the development of his maturity, was his uncle. The boys uncle is a symbol of the boys father figure. The boys uncle always seems to be stressed with the difficulties of his life. He shows that he is stressed by the way that he comes home late and forgets things. When the uncle forgets that the boy wants to go to the bazaar, he does not sound like he cares about what the boy wants to do, but yet, he also is perceived to be very humble about these things. He exemplifies that he does not really care about what the boy wants when the boy tries to tell his uncle that he wants to go to the bazaar. All that the uncle does is get off of the topic and he begins to ask questions about The Arabs Farewell to His Steed. The boy does not get angry though; he just walks away which shows he has developed maturity. By coming home late to take the boy to the bazaar, the uncle again shows how he does not care about what the boy wants to do. Again, the boy is not perceived to be angry at this point. He is only described as not smiling. By acting that way, the boy sounds as though he is learning to cope with the various stresses of becoming an adult. As the boy gets older, he will not want to be like his uncle, and therefore, he will have matured in that sense. Other than the boys uncle, who is essential in the development of the boy, there is yet another character that is also just as important. Madame Bovary vs The Awakening Essay The priest also makes an impression on the development of the boy. Now, the priest has already died in the back drawing room of the boys .