Intensive care Essay

1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the Creactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7) a. What predisposed the patient to develop septic shock? b. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?  c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication? d. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient? e. Explain the importance for nutritional support for this patient and which type of nutritional support should be provided f. What are your priority interventions? Nursing/ Medical ( 3-4 ) 2. Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9 °F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock. The following orders are written for the patient: Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line Obtain complete blood count, serum electrolytes Oxygen at 2 L/min via nasal cannula Type and cross for 4 units of blood Flat plate of the abdomen STAT (Learning Objectives 1, 4, and5) a. Describe the pathophysiologic sequence of events seen with hypovolemic shock. b. What are the major goals of medical management in this patient? c. What is the rationale for placing two large-bore IVs? d. What are advantages of using 0.9% NS in this patient? e. What is the rationale for placing the patient in a modified Trendelenburg position? Case Study, Chapter 13, Fluid and Electrolytes: Balance and Disturbance 1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. a. What are possible causes of a low potassium level? b. What action should the nurse take in relation to the serum potassium level? c. What clinical manifestations might the nurse assess in Mrs. Dean? 2. Conrad Jackson is a 28-year-old man who presents to the emergency  department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he â€Å"ate something bad.† Upon admission his vital signs are a temperature of 102.7 °F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. (Learning Objective 7) The following results are returned from the laboratory: Sodium (Na+) 150 Potassium (K+) 5.5 Chloride (Cl ¯) 110 BUN 42 Creatinine 0.8 Glucose 86 pH 7.32 PaCO2 35 HCO3 ¯ 20 PaO2 90 O2 Sat 98% a. What is your interpretation of this arterial blood gas sample? b. Explain the high potassium in this patient. c. Calculate the patient’s anion gap: d. What is the interpretation of this anion gap? 1. Complete a plan of care for a patient with an electrolyte imbalance: fluid volume deficit and fluid volume excess; sodium deficit (hyponatremia) and sodium excess (hypernatremia); potassium deficit (hypokalemia) and potassium excess (hyperkalemia). Specifically, include altered laboratory values. 2. Create a Plan care for a patient with multiple organ dysfunction syndrome (MODS).

Assess Functionalsu and New Right View of the Family Essay

Functionalists believe that the family have specific or traditional functions within the family. One function of the family would be reproduction or having children as this is imperative for the world as they will be the future workforce. For example family businesses will need to pass down the factories/shops to the next generation in the family for the continuing of the ancestors business. Other functions include economic maintenance this is where the family provides necessities for all the family members for example shelter, food and clothing. Another is that the family helps teach children how to socialise with others and also educate them with the correct norms. An important function of the family is that it gives a sense of identity and belonging for example the family allows people to be able to rely on because they are connected through family. Talcott Parsons is one of the key functionalists that strongly argued that the nuclear family fits the needs of the contemporary family and so believes that that extended family, which could involve divorce, will prevent the family from growing and being taken care of. He supported the traditional functions of the family and spoke about how the modern family is changing a lot of the former functions. Parsons identified two remaining functions within the family one being primary socialisation of young which is when the parents raise the children and educate them about the norms and values for example the rights and wrongs so they are able to pass them one. For example in abusive families negative norms are passed on. However how they act in other ways depend on their school life. The other main function is the stabilisations of adult personalities which is where children turn into adults and are forced to ‘grow up’ and get a job and buy a house etc. they are made to take things more seriously in the world so they are able to achieve a sense of belonging on their own and actually have a purpose. Overall Parson’s view of the family is centred around the middle and upper classes and focuses on the male’s purpose and ignores the female perspective. This suggests that parsons believes women are happy to be housewives and don’t aspire to be anything else but loyal to their husbands. A few positive functions of the family is that they are much more financially stable as the husband and father have a stable job and are able to earn enough money to support the whole family. The nuclear family also results in a much closer relationship between family members as they are with each other daily and so relationships are created. For example siblings are taught to share with each other and so form a bond of trust with each other. Children in the family are more likely to stay on a positive path if they are in a nuclear family as disruption could cause difficulties with school life and social life. Married parents are seen to be very good role models when they are part of a nuclear family. However a disadvantage of the nuclear family is that functionalist advertises it so it seems to be very isolated and private and therefore they are seen to have a poor social life because they keep to themselves and don’t concern themselves with wider groups of people. The family becomes attached to home leisure with TV the internet and games resulting in them becoming more home-centred. The family makes little contact with neighbours and is very self-contained. The family as a result of being private becomes reliant on support from the welfare state. Alternatively functionalists are said to idealise the family life too much. Therefore ignore the rising divorce rates. They refuse to acknowledge the negatives about the changing family life, and the growing family diversity. Another view would be those functionalists don’t take in account the abuse that can occur within any families. That is a reason as to why the modern family is changing, it’s due to the fact that the laws against domestic violence have become much stricter. This leads to the feminists who argued against this nuclear family as it portrayed women in a way that was very sexist. Ronald Fletcher a British sociologist who agreed with the functionalist’s perspective but argued that modern societies are changing and that there is an increase in modern functions in the family such as regulating sexual behaviour and the increase in parental involvement in their education. Other includes the being responsible in the rearing of children and caring for dependent people whether young or old. All these factors contribute to the changing family life and their morals. More and more people are starting to argue like Fletcher that the nuclear family is the dominant family structure but that its modifying over time for example mothers are now getting jobs as well as husbands so they both support the house hold and aren’t dependent on just one person for the whole family. Charles Murray a social scientist says ‘the traditional family life is under threat’. His main concern was with the welfare benefits that single women were being given. He thought that it was too easy for them to leave the nuclear family and live alone and just depend on benefits. Murray also argues that being or living with a single parent on benefits is giving the wrong role models to children as they are able to see that they can live alone and live off benefits so don’t strive to achieve any goals. There are fewer father figures to show discipline as the mother could lose control so the children go down a path of drug dealing vandalism and crime which gives a very positive look on the new right approach. Halsey and Dennis who agrees with what Murray argues saying that single parenthood and absent fathers is one of the key issues with the decrease in nuclear family lives. Due to the lack of jobs and rise in unemployment men are starting to struggle to maintain their title of bread winners and the industries are changing from heavy workloads so women are more likely to find a job in modern times. As a result men may be reject by the women as they can’t financially depend on them so would rather be given benefits than struggle to keep a roof over them and their children’s heads. Halsey debates that being in a one parent family with the factors of unemployment and poverty being high could inevitably lead to crime and vandalism by the younger members of the family. Against a nuclear family with a stable income and stable household would again lead to any crimes and vandalism by the offspring in the family. Abbott and Wallace’s critically judge the new right about how women are being exploited in the families and how a lot of frustration and unhappiness is able to be experienced by living in this environment. The new right also disagrees to acknowledge the violence that can be cause in a nuclear family life and the abuse a family can actually suffer from being forced to stay and live with them as it isn’t socially acceptable to be a one parent family. Some of the ideas that Abbott and Wallace criticised are that the new right are opposed to having an easy availability to a divorce; this again goes against women having the right to leave a violent family life and actually possibly saving theirs and their children’s lives by leaving. Again the new right disagrees with abortions as they say the foetuses have a right to life but Abbott and Wallace criticise this because bringing a baby into the world is a big thing and some people are unable to care for the baby correctly. The new right makes men have a very stressful life as they have a whole family dependent on them as a role model of a breadwinner and the same with women being role models for the girls and showing how much work goes into being involved in a family. Abbott and Wallace favour letting people take control of their own lives by living alone or being involved in a homosexual relationship or even women being the breadwinners while men are in charge of the household and children. Some of the traditional family values that the new right followers agree on bringing back involve that a woman’s place is in the home and shouldn’t be working as a bread winner as that’s the mans job as head of the household. This is associated with gender patriarchy as women are treated completely different to the way men are, and so it’s seen as unfair and sexist in the modern day. Gender patriarchy would be one of the main factors that feminists would argue about as they say women are oppressed by the nuclear family and its rules and values. Different feminist groups argue about different factors, liberal feminist argue about sex discrimination and want changes in the law to be made. However radical feminists argue against men patriarchy, where men are seen to have more power for example women are considered to be responsible for raising the children and choosing and cooking the food and keeping the home as welcoming as possible. Traditionally a man would never be seen do to the cooking or cleaning as it was seen as a wife’s job but in modern times it’s a much more equal task. There are however some positive aspects as to why many people agree with the new rights theory as Brigitte Berger, who defends the nuclear family by saying it’s a very positive feature of modern societies as it helps the youth of the world understand decency, common sense, politeness and respect for others. These values and morals will help make a better life for the person as common decency is seen as a norm and many people agree that in a single parent family the mother might find it s a struggle to teach the children all of that on her own due to the lack of help from the father figure.

Integrating Major and Core Essay Example | Topics and Well Written Essays - 500 words

Integrating Major and Core - Essay Example As a network administrator, the concepts about ethics and self morality are essential because it allows me to explore myself as a person and not just as a network administrator. For example, it is clear that I must think like a human before putting my network administrator hat on. Additionally, one must understand the principles of networking ethics that come with it, which will really help me In 21st century, the recent era of concepts of community surrounding technology has been a dogmatic notion. We are constantly bombarded with security risks and threats. One of the main risks as a network administrator are security threats and how it can affect the community I reside in. For instance, the concept IT systems continue to evolve, security becomes a crucial element that must be carefully analyzed. Most organizations feared cloud computing because of its ability to be flexible within user domains. This poses a problem for organizations that did not have scalable solutions, but needed the concept of security embedded within their data. Corporations prefer private clouds because administrators control access through policies which designate capabilities. In addition, there are many opinions regarding technology scientists discussing the functionality of networks, specifically in regards of private clouds, who have a great capability to maintain a secured environment and be integrated with a public cloud. The main core classes will facilitate my growth in a similar fashion. As a matter of fact, these notions dominate the public community Moreover, the delegated administrators can manage a scoped environment. Without a doubt, it is still unclear how safe out-sourced data is and when using these services ownership of data is not always clear. Another concept is delegating network access that is not moral, such as watching adult videos over the

Positioning and differentiation strategies Essay

Positioning and differentiation strategies - Essay Example Positioning strategy is influenced by the attributes, the types of the consumers who are involved in this process, application and the object attributes. Differentiation strategy is concerned with developing the unique products and services for different types of customers. Differentiation strategy is considered as one among the three generic marketing strategies. Mayo Clinic has been established for offering the best available services to its patient through the integrated clinical practice and the education and research. For developing the reputation of the clinic it has focused on the positioning strategy. Mayo Clinic in order to attract more of its customers or patient has concentrated on the needs and the requirements of the patients and it has also developed the level of commitment of its staff. In terms of the cost, Mayo clinic have engaged lot of engineers in there clinic who are constantly engaged in improving the efficiency of the science and technology. The clinic has a training centre that guides or assists the staff in the use or the application of the technology for removing or decreasing the waste and therefore it has taken various initiative that will result in the better or suitable outcome that will be safe for the patients and therefore it has focused on providing the better services at a affordable and reasonable cost that will increase the value of the clinic. Mayo clinic has positioned itself as a diagnostic centre. The positioning is considered as an important strategy for developing and increasing the customer base and also the brand equity. The positioning strategies of Mayo clinic is mainly focusing on driving the growth , achieving the goals and the objectives defining the brand, improving the services and understanding the patient and offering the best available services to its patients. Since there are different positioning strategies adopted by

Distinguish Knowledge from Opinion Essay Example | Topics and Well Written Essays - 1250 words

Distinguish Knowledge from Opinion - Essay Example In Plato’s Meno, Socrates and Meno argue about what virtue is and whether it can be taught. What ensues is an exchange of ideas which lead Socrates to further prove his point – that virtue cannot be taught and is rather simply recalled. For Socrates, â€Å"the soul is immortal† and therefore â€Å"there is nothing which it has not learned.2 The soul therefore only has to draw out from its reservoir of knowledge all the truths that can be known. In order to prove this point, Socrates calls on a young servant boy of Meno’s and begins using the elenchus on him, hoping to draw out the truth from him without teaching him anything. Socrates begins his demonstration of the elenchus by drawing a 2 ft. x 2 ft. square on the ground. This square has an area of 4 square feet and Socrates then asks the boy how to come up with a square double this area, which is 8 square feet. Through a series of questions and answers using a trial-and-error method, Socrates and the __ ________________________ 1 Gladwell, p. 197. 2 Baggini & Fosl, p. 13. boy finally come to a conclusion that double the area of the given square is the square of its diagonal. Many times during the interrogation, Socrates points out to Meno that he is not teaching the boy and rather makes him remember the truth. ... For the French philosopher, the means of finding true knowledge is through skepticism, or the method of casting doubt on all arguments, principles and beliefs until any of these could be proven true. Descartes’ principle of â€Å"methodological doubt† begins when he notices that his senses sometimes deceive him.4 He then proceeds to wonder what is real and what is not. He thinks that everything that he can perceive through the senses may merely be opinion and not the truth for he can doubt the existence of these things. Moreover, the fact that he may be deceived by the senses also somehow makes him cast doubt on the goodness of God, for he wonders why a good God would allow him to be deceived. As this deceptive quality does not fit Descartes’ notion of a good God, he replaces God with an â€Å"evil genius† that possesses the power to deceive him completely.5 With such a powerful evil force, Descartes then begins to doubt everything else, even the verity of mathematics and geometry, and he asks himself, â€Å"What then will be true? __________________________ 3 Baggini & Fosl, p. 16. 4 Ibid., p. 50. 5 Ibid., p. 52. Perhaps just the single fact that nothing is certain.†6 Descartes, however, finally comes up with the conclusion that, despite the fact that the existence of everything can be doubted, he exists: â€Å"†¦there is no doubt that I exist, if [the evil genius] is deceiving me.†7 Descartes then takes it from here and he supposes that the fact that he is being deceived rests upon the fact that it is because he thinks so. With the premise that he as a thinking being now exists, Descartes is able to conclude that he as a thinking being can also doubt, understand, affirm, imagine, sense and perform many other functions related to thinking. Moreover, using

Unit 3 Part 1 Essay Example | Topics and Well Written Essays - 500 words

Unit 3 Part 1 - Essay Example Anderson and Bushman (2001), provide a better understanding of such effects on viewers. Their scientific research states that, â€Å"Violent media increase aggression by teaching observers how to aggress, by priming aggressive cognitions (including previously learned aggressive scripts and aggressive perceptual schemata), by increasing arousal, or by creating an aggressive affective state.† The violent video games are not only affecting the social, psychological and physical wellbeing of children but are also affecting their activities including education, family relationships and interating abilities. In this regard, Lynch et al. (2004), provide studies which â€Å"show a fairly consistent negative correlation between recreational video game play and grades.† Children, who are aggressive by nature without any external factor increasing this aggression, are more likely to be affected by such video games. A correlational study conducted by Anderson and Dill (2000) concludes that the relationship between violent video games and aggression are more likely to be devastating for children having aggressive behaviour or showing negative behaviours in their early life. The main result of the study by Baldacci, Pasold, Baumgardner, & Funk (2004) proposed that media exposure directly relates to the desensitization of children from violence. It also leads to lower empathy when it comes to real life violence. The more a child is exposed to violence in media or video games the more he is desensitized to his surroundings. Similarly it was also found through the study the empathy level of the children was also significantly lowered down with the increased exposure to media and games. Hence, we may conclude that the effects of violent video games and exposure of violence on media is affecting children greatly. There is a need to research the effects in depth and analyze the changes that occur in children’s behaviour after getting exposed to media

Marketing Management Essay Example | Topics and Well Written Essays - 3250 words

Marketing Management - Essay Example According to Kotler (2003), customer perceived value (CPV) is the difference between total customer value and total customer cost. Total customer value includes four factors: product value, services value, image value and personnel value; and total customer cost includes time cost, monetary cost, psychic cost and energy cost (Tseng & Et. Al., 2007). The enhancement of the consumer perceived value can be achieved by increasing total consumer value or by reducing total consumer cost. This can be understood better with the help of an example of Wal-Mart, the UK based retail chain of stores. To enhance the consumer value they offer huge assortments in merchandises. There are various options available for the consumers to chose from the various brands and their private level brands. In reduction to consumer cost, Wal-Mart offers ‘everyday low pricing’ strategy. This offering allows the consumers to save certain amount of money through the low pricing strategy of Wal-Mart. This helped Wal-Mart to cater its consumers’ added value through higher level of satisfaction (IMD, 2009). This model suggests that how received and desired values adjust well into a disaffirmation type satisfaction model. The overall satisfaction can be known as the consumer’s judgment in reaction to assessment of understanding with the products and services. When the consumers make an evaluation, they create certain notions, developed from the past and present experiences about the value that they desired. The desired value directs consumers when they structure perception of the products or services whether it has performed excellently or weakly in the utilisation circumstances. The consumer’s derived value is evaluated upon experiences they use on certain attributes of the experiences, performances and consequences. The received value may guide in the creation that is generally