Wednesday, December 4, 2019

Objective Structured Clinical Examination Method

Question: Discuss about the Objective Structured Clinical Examination Method. Answer: Introduction: Mr. Harry Jones is 68-year-old man and is admitted to the medical ward suffering from Rapid Atrial Fibrillation. He has allergy with penicillin , and has a past medical history of asthma and hypertension. Mr. Jones is currently on Salbutamol 5mg two puffs four times per day and, oral cardiprin 100mg once a day and oral enalapril 10mg daily. He has a known family history of acute myocardial infarction, migraines in mother , and cancer of the colon in his father.This report includes pathophysiology of atrial fibrillation, and the rationale of administrating amiodarone as his initial medical management, and action and the therapeutic benefits of both the drugs warfarin and dabigatran as well as the side effects to decide which drug most suitable for him. Mr. Jones was prescribed aspirin to prevent the heart stroke, which can occur due atrial fibrillation since he has an age of 68 years. This drug was given because of low risk of bleeding, easy to use and monitoring is not required while giving this drug(Lip, 2013).The Mode of action of aspirin involves inhibiting the activation and aggregation of platelets and also the inhibition of enzyme cyclo xygenase that is platelet dependent. This leads to the inhibition of prostaglandin synthesis. The side effects of aspirin involves fever that lasts for 3 days, vomiting, pain in the stomach and nausea. Cardiprin is used for thinning of blood during heart strokes and atrial fibrillation. It has an active ingredient as aspirin and functions by the suppression of the production of prostaglandins hormones. There are various side effects of Cardiprin such as nausea, vomiting(Ng Ho, 2017). Asthma and problems related to digestion. Nursing interventions for administering Cardiprin involves proper knowledge about the current medicaments the patient is taking, allergic responses and any future surgery and pregnancy. The patient should inform the doctor about any issues of asthma, high blood pressure, heartburn or any other cardiac diseases. The nurse should give the medicine to the patient by checking on the outer packaging and as prescribed by the clinician. It can also lead to irritation in the stomach so it should be taken along with milk. The pathophysiology of atrial fibrillation involves pathological changes such as fibrosis in the artria that is progressive in nature. The fibrosis occurs due to the ageing process, dilation of the chamber, genetic reasons and inflammation. Atria gets dilated due to various structural abnormalities in them heart such as high blood pressure, valvular heart disease or a congestive failure of the heart (Heitner, 2013).Atrial fibrosis can also occur due to the mutation in the lamin AC gene. The renin-aldosterone angiotensin pathway is activated by the atrial dilatation due to stretch and this in turn increases the protein disintegrin and matrix metaproteinase in the walls of the atria. This pathway leads to the release of cytokines, oxidative stress and the formation of factors that lead to growth and promote fibrosis(Wakili, Voigt, Kb, Nattel, 2014). It also initiates various cell-signalling processes that increase the level of calcium inside the cells. The Renin aldosterone angiotensin system (RAAS) includes various enzymes such as Angiotensin 2, aldosterone and angiotensin converting enzyme and they are increased during atrial fibrillation as they are synthesized on a local level in the atrial myocardium. The increase in the level of these enzymes leads to fibrosis and atrial remodeling and results in the loss of muscle mass of atria.There are two types of fibrosis that is Reactive interstitial fibrosis, which helps in the separation of muscle bundles, and Reparative fibrosis that helps in replacing the cardiomyocytes. Fibroblasts can be coupled to the cardiomyocytes in an electrical manner and help in promoting the ectopic activities when their number is increased(Dan Camm, 2013). Amiadarone is given to Mr Jones to prevent myocardial infarction since his mother had a past medical history of the same disease. Amiadarone is also used to help the heart to beat in a normal manner as he is suffering from atrial fibrillation. It may lead to side effects if given to Mr Jones since he is allergic to pencillin and is suffering from asthma and serious heart issues(Barber Blundell, 2013).It should also be not given to patients suffering from thyroid diseases, implantation of pacemaker, eyesight issues, low balance of electrolyte and low or high blood pressure. There are various side effects of amiodarone such that it can have a negative effect on the liver and lungs in Mr Jones. The nursing interventions include various measures after administering this drug to the patient such as continuous monitoring of ECG and rhythm and heart rate and keeping a check if the patient suffers from jaundice, pain in the chest and stomach breathing issues, dark coloured urine and blood i n the cough(Schalij, 2014). Amiodarone should not be given to females who are pregnant as it can have a negative effect on the health of the baby because it passes to the mothers milk. Anticoagulants such as warfarin and dabigatran are used to reduce the risk of blood clotting and hence the heart stroke. The most common medicine is warfarin but it has a disadvantage that it can interact with foods, medicines and alcohol. But dabigatran has an advantage that it has a low interaction rate with medicaments, alcohol and food items .Warfarin requires regular blood tests to check the clotting time of blood in the body and dabigatran does not require regular blood tests(Wislff Klemp, 2014). According to, the National Institute for Health and Care Excellence (NICE), warfarin is used to decrease the risk of heart stroke. Its main disadvantage is heavy bleeding so to avoid it, a Vitamin K injection is given to stop the bleeding. Dabigatran blocks the effect of thrombin and helps in preventing the blood clots. Thrombin is a protein which is formed in the body for the formation of blood clots. Dabigatran gets collected in the blood of the patients who suffer from kidney probl ems as the kidney is not able to remove the drug from the body(Giugliano, Ruff, Braunwald, Murphy, Wiviott, Ruzyllo, 2013). There are various precautions while taking the drug dabigatran such as the capsule should not be opened before giving then dose to the patient that will lead to an increase in the concentration of drug in the body of the patient and hence lead to an increase in the risk of bleeding. Another disadvantage of this drug is that it is degraded when comes in contact with moisture and hence precautionary measures should be followed to keep the bottle closely tight. It should be used within 30 days after the bottle is opened. A side effect of dabigatran is that it leads to indigestion and stomach upset in patients if it is discontinued because the drug needs an acidic environment to get absorbed in the body(Mooney, 2013).It can also lead to heart stroke or heart attack if this medicine is stopped from taking. The side effects of warfarin are fever, bleeding from the gums, pain and swelling, irritation and diarrhea. Warfarin is more effective and safer than dabigatran and dabigatran should no t be taken by patient suffering from kidney and liver problems as it lead to increase in bleeding. Salbutamol is used in the treatment of asthma by providing relaxation to the muscles in the walls of airways present in the lungs. The normal dose for patients is 1-2 inhalations those who are adults and one puff for children in the age group of 6-11 years. It should be used only after prescribed by the doctor. (Salvi, 2013). Mr Jones will be instructed to remove the cover from the mouthpiece and shake the inhaler profusely then hold the inhaler and breathe out in a gentle manner. Then the mouthpiece should be immediately kept on the mouth. He will be advised to seal the mouthpiece totally with lips and start to breathe slowly with the mouth. After breathing slowly, press the inhaler firmly to release the medication and continued to breathe in(Zhang, Liu, Hu, Tan, 2015). If the patient misses the dose he should continue with the regular dosage schedule. It should be store at a room temperature and kept out of reach from children. It should be kept away from hot devices such as stove and heater. The patients who are allergic to salbutamol and milk proteins such as lactose should not take salbutamol puffers. Side effects of this medication include drowsiness, dizziness, fatigue, coughing and faster rate of heartbeat(Lahiri, 2017). It can be concluded that Mr Jones has a high risk of heart stroke since he is an elderly person. He should take proper care of himself and follow the medicaments prescribed by his clinician properly. He should take a well balanced diet and exercise daily that will decrease the chances of heart stroke. He should take warfarin that will help to decrease the risk of heart stroke and it is more effective and safer as compared to other drugs such as dabigatran. He should follow proper nursing interventions and follow precautionary measures to recover from Rapid Atrial Fibrillation. Bibliography Barber, Blundell, P. . (2013). Further Esstentials of Pharmocology For Nurses. Maidenhead: McGraw-Hill Education . Dan, Camm, B. d. (2013). Atrial fibrillation therapy. . Giugliano, Ruff, Braunwald, Murphy, Wiviott, Ruzyllo, H. . (2013). Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine , 369(22), 2093-2104. Heitner, H. . (2013). Cardiology in Family Practice. A practical guide . Lahiri. (2017). vidence behind use of levosalbutamol over salbutamol to prevent cardiac side effects. . International Journal of Contemporary Pediatrics , 4(3), 674-678. Lip, . L. (2013). Stroke prevention with oral anticoagulation therapy. Circulation Journal, Volume 77(6), pp1380-1388. . Mooney. (2013). Use of dabigatran to prevent stroke in patients with atrial fibrillation. .Nursing standard, Volume 27(27), , pp 35-41. Ng, Ho, C. . (2017). Comprehension by older people of medication information with or without supplementary pharmaceutical pictograms. Applied Ergonomics , 58, 167-175. Salvi, B. . (2013). Aspirin and asthma. CHEST Journal Volume118 (5 , p1470-1476.doi:10.1378/chest.118.5.1470. Schalij, V. E. (2014). Amiodarone: an effective antiarrhythmic drug with unusual side effects. Heart, Volume , 96(19). Use of dabigatran to prevent stroke in patients with atrial fibrillation. (2013). Nursing standard, , Volume 27(27), pp 35-41.41. Van Erven, L., Schalij, M. J. (2010)Amiodarone: an effective antiarrhythmic drug with unusual side effects. . (2013). Heart, Volume 96(19) , 96(19). Wakili, Voigt, Kb, Nattel, D. (2014). Reccent advances in the molecular pathophysiology of atrial fibrillation. Journal of clinical investigation , p2955-2968. Wislff, Klemp, H. . (2014). conomic evaluation of warfarin, dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation. . Pharmacoeconomics , 32(6), 601-612. Zhang, Liu, Hu, Tan, X. (2015). An aerosol formulation of R-salbutamol sulfate for pulmonary inhalation., . Acta Pharmaceutica Sinica B , 4(1), 79-85.

Sunday, November 24, 2019

Key Facts About Edmonton, the Capital of Alberta

Key Facts About Edmonton, the Capital of Alberta Edmonton is the capital city of the province of Alberta, Canada. Sometimes called Canadas Gateway to the North, Edmonton is the farthest north of Canadas large cities and has important road, rail and air transportation links. About Edmonton, Alberta From its beginnings as a Hudsons Bay Company fur trading fort, Edmonton has evolved into a city with a wide range of cultural, sporting and tourist attractions, and is the host of more than two dozen festivals each year. Most of Edmontons population works in the service and trade industries, as well as in the municipal, provincial and federal governments. Location of Edmonton Edmonton is located on the North Saskatchewan River, near the center of the province of Alberta. You can see  more about the city in these maps of  Edmonton. It is the northernmost large city in Canada and, therefore, the northernmost city in North America. Area Edmonton is 685.25 sq. km (264.58 sq. miles), according to Statistics Canada. Population As of the 2016 Census, Edmontons population was 932,546 people, making it the second-largest city in Alberta, after Calgary. It is the fifth-largest city in Canada. More Edmonton City Facts Edmonton was incorporated as a town in 1892 and as a city in 1904. Edmonton became the capital city of Alberta in 1905. Government of City of Edmonton Edmonton municipal elections are held every three years on the third Monday in October. The last Edmonton municipal election was held on Monday, Oct. 17, 2016, when Don Iveson was re-elected as mayor. The city council of Edmonton, Alberta is made up of 13 elected representatives: one mayor and 12 city councilors. Edmonton Economy Edmonton is a hub for the oil and gas industry (hence the name of its National Hockey League team, the Oilers). It is also well-regarded for its research and technology industries. Edmonton Attractions Major attractions in Edmonton include West Edmonton Mall (the largest mall in North America), Fort Edmonton Park, the Alberta Legislature, the Royal Alberta Museum, Devonian Botanic Garden and the Trans Canada Trail. There are also several sports arenas, including Commonwealth Stadium, Clarke Stadium and Rogers Place. Edmonton Weather Edmonton has a fairly dry climate, with warm summers and cold winters. Summers in Edmonton are hot and sunny. Although July is the month with the most rain, showers and thunderstorms are usually short. July and August have the warmest temperatures, with highs around 75 F (24 C). Summer days in June and July in Edmonton bring 17 hours of daylight. Winters in Edmonton are less severe than in many other Canadian cities, with low humidity and less snow. Although the winter temperature can dip to -40 C/F, the cold spells last only a few days and usually come with sunshine. January is the coldest month in Edmonton, and the wind chill can make it feel much colder.

Thursday, November 21, 2019

Portfolio 02243 Essay Example | Topics and Well Written Essays - 2500 words

Portfolio 02243 - Essay Example Thus, our family have to learn English for meeting the global requirement. However, being the native peoples we were facing the challenges of speaking English correctly. In terms of learning English or other foreign languages like German and Spanish my Mandarin pronunciation got inaccurate and my parents helped me a lot to rectify the languages (Grainger, 2014). My education emphasised on the first language Mandarin which is my native language. I have faced multilingual issues in the Jiangsu are different languages are used by the local peoples. I observed that the maximum peoples of my school are using Mandarin languages, some of them using English, German and Spanish to communicate with the others. From the age of 12, I selected German as my second foreign language. However, I faced intense complexity in learning the foreign language in classrooms. Major I faced problem was the accent of German language. Very less number of peoples was using the language thus I did not have the scope of learning the methods of oral communication. Teachers were just teaching us the methods like paraphrase of Chinese and German, and some basic grammars. I have started to communicate with European classmates to improve my accent of English and German. Discussion helped me to gain insight on various critical incidences and cross cultural traits. The discussion of CT 5 provided me with the details of Mr J and Mr S. From the discussion it is observed that Mr J is working in a foreign country which unfamiliar to him as per the culture and languages. Mr J took the help of the Mr S to understand the culture of the new country. However, it is also observed that the culture of Mr S is empowering the hangouts and spending time with friends and acquaintance. They can interact with the immigrant or the foreign country members very easily and they are very helpful (Beausaert, Segers and Gijselaers, 2011). Culture of the country

Wednesday, November 20, 2019

Team Leadership Case Study Example | Topics and Well Written Essays - 1250 words

Team Leadership - Case Study Example Furthermore, the team lacks excellence standards through which individual performance can be assessed. Individual performance should be established at each level in order to identify and correct any wrong doings (Martin 253). With lack of such essential qualities of effective teamwork, it can really be very difficult for the team to attain its goals. Jim should intervene immediately if he wants his team to achieve effectively and with ease its goals. Since his group comprises of individuals with very high expertise, Jim can utilize this opportunity and intervene from within. As an executive leader he should have a clear SWOT analysis of his team in order to approach situations strategically. This will help him to utilize every opportunity/strength the team is exposed to appropriately while avoiding the team weaknesses as well as overcoming the threats. Nevertheless, his intervention should be task oriented even though relational actions may also come into play at times (Martin 254). Jim’s group seems to have no problem with their leader but rather have a problem with what they are expected to do. Jim should define to each individual clearly what he expects of him/her and the exact goal they are expected to achieve. ... Structuring here implies that members’ strengths as well as weaknesses needs to be studied in order for each member to be allocated what they can do best. Decision making is also of equal importance in the process of leading, as it facilitates the process of attaining results. Jim should also ensure that standards are maintained at every step through a constant monitoring and evaluation process. A close analysis of the group will enable him to identify any misunderstandings within the group, and rectify them before they become a major problem. Local Cancer Health Team Teamwork is all about proper communication, listening and understanding each other. Without these qualities group effectiveness which plays a critical role in teamwork is not going to be achieved. Team effectiveness aims at ensuring that tasks are accomplished within the stipulated time, as well as maintaining a strong teamwork. This team may actually fail to accomplish their vision due to poor developments withi n the team. Each individual should be accorded respect in what she/he has been allocated in the team and no one should feel superior over the other. Since within this team other members feel that they know more than others, the team is likely to lack cohesiveness as conflicts may arise (Martin 255). In this team problems are arising from both internal tasks and relations since the two exist co-currently. Conflicts resulting from tasks are likely to spread to internal relations where other team members will feel undermined. As much as it is team work, no one should be looked down upon since it is expected that duty allocation is based on specialty. Doctors in this team however are overstepping their mandate to an extent that they are

Monday, November 18, 2019

Metaphors on Teens Essay Example | Topics and Well Written Essays - 1000 words

Metaphors on Teens - Essay Example Communicating with your teenager on a regular basis Communication is blinding family with love, care, support, and bringing a parent-teen relationship to harmonious respect. Teens are spending less time talking with their parents and more time with peers, deteriorating and disconnecting their relationship. In this scenario, communication is needed to prevent relationship from being torn. Just as food and air are necessary for human survival, so is communication necessary for the development and sustainment of a relationship. Thus, communication is like a bridge that connects two separate ways into one. Communication is a tool for showing love and interest, resolving conflicts and issues and a means of building close relationships. As supported by Norbeck and Fitzpatrick (125), in a parent and adolescent relationship communication is a commonplace means of understanding. Meanwhile, teens of today are more exposed to negative influences through factors such as technology and peer press ure --destructing powers that increase as time ages. Therefore, teens must be parented properly and should be treated and comforted like a pillow. How to parent your teens with love and compassion Children are highly precious people to their parents’ lives. ... â€Å"Am I a controlling parent? Do I listen to my child?† parents often wonder. Parents, especially those who are autocratic, want their teens to follow every command and rule they impose. However, just as if too much weight is placed on a bridge it will break, so will parents acting too strictly result in cracks in the relationship. Indeed, if parents are too strict in not considering teens’ feelings, desires and opinions, conflict may arise. Parents must show love and compassion to their teens despite disobedience. Teens want to be loved and cared by parents, and see their parents as their protective shield when it rains. There are many ways parents can show love and compassion to their teens. According to Taylor (2005), parents must teach love and compassion so that teens understand its essence. Second, parents must plan activities that establish compassion and increase love, such as family outings, family prayer and scripture study, and watching movies together etc . Meanwhile, teens might get mistaken, so it is a perfect time for parents to show love and compassion through comforting, teaching teens how to make decisions, and â€Å"encouraging them to rise after having stumbled down.† How to parent the stubborn and argumentative teenager through peer pressure At their age, teens are like the ball that keeps on rolling. Peer pressure greatly influences teens’ behavior as they might apply what they have learned from peers. Some teens are stubborn and very augmentative. Parents of this kind have hard times negotiating with them. According to Thompson (2006) some teens often love to argue and persist in their ideas. They want to be always right, and do the things they want. Parents want the best for them, so generally what they consider is the best and

Friday, November 15, 2019

The Success Of The Woman In Black

The Success Of The Woman In Black Susan Hills novel The Woman in Black was written in the Gothic tradition. Specifically, she wanted to write a Victorian Ghost story, even though her novel was written in modern times. Stephen Mallatratt, in adapting the novel into a play, wanted to stay within the novels tradition, especially by focusing on terror instead of horror: Darkness is a powerful ally of terror; something glimpsed in a corner is far more frightening than if its fully observed. The play contains many classic Gothic elements, including: Tension, True story, Sounds, Whispers, Bangs, Ghost/Person to get scared, Darkness and a House/lonely place. The Woman in Black is a scary gothic play. Stephen Mallatratt, the playwright, achieves a terrifying effect through writing an effective mise-en-scene. These include the setting, lighting, props, sound, the text and stage directions for actors, these combine and make a nerve shredding experience Stephen Mallatratt also uses lighting effectively, this is seen in (p40) when Kipps takes up the torch and moves outside, fade to black-out on stage this is very daunting as the stage is pitch black you dont know what is going to happen next, this creates a mysterious setting and truly nerve-shredding experience for the audience. In addition, another area the light was used effectively was the scene that when Kipps is looking for Spider in act III. The Woman in Black is in the nursery where it is light however, she is outside the light, yet we see her as a crow-like silhouette, violently flapping in the dark. The use of light plays on the audiences emotions; as we are conditioned to believe black represents evil and light represents good. One of the techniques that the author uses to make the play nerve-shredding is sound. For example, as the noise of the ponys hooves gets louder and louder as if its coming closer, a childs cry rises to a scream of terror which is then choked and drowned. The audience should feel the fear and worry of what was going to happen next. Another example is seen in the play for example when the Market noises fade and foot steps echo (p19) Mallatratt uses this to show the audience that the scene is taking place out side and to give a chilling, eerie affect on the audience. As The lighting dims slightly to give filtered effect through trees. They walk on, which creates an atmosphere to the scene. This includes, a moody and foggy setting, however, Kipps and Mr Daily acts as if they are going into a church, Kipps I take it she is to be buried in the churchyard? discussing about The Woman in Black. The stage props were minimal due to the limited amount of space at the theatre. Therefore, the props that were used had to create maximum effect. These included, a wicker basket, clothes hanging on a rail and chair for the actors to sit on. The wicker basket was used as a prop to illustrate a train carriage, a bed, horse carriage and a desk. The clothes rail was situated up stage and never moved from its position. The purpose of this prop was to illustrate a cloak room. The chair was used by the actors to portray someone sitting on a train. Alternatively, as piece of furniture in a room; for example, a desk chair or an arm chair. In the play Mallatratt only uses three actors. Kipps plays many roles, his main is narrating the story; however, Kipps also plays Keckwick and Mr Daily. This is due to Kipps not feeling confident enough to tell his story; therefore he tells an actor who plays Mr Kipps. Whilst he is telling the actor the audience become aware of his story through the actor. The Woman in Black is the final actress; she is used for effect as the actress has no lines. The main purpose of this actress is to create fear in the audience. The audience on view her when Mallatratt is creating terror. There are very thorough stage directions given throughout the play from the skip he takes out the bottle of brandy and a glass and pours himself a largish measure. This is an example of the detail Mallatratt uses in his stage directions. Therefore, any director could re-capture the same effects from his stage directions. Furthermore, his stage directions include lighting and sound effects the lights have dimmed to virtual darkness. This illustrates that Mallatratt uses light to give an illusion or effect of eeriness and emotions of fear to the audience. The director uses sound for effect as the sound fades down, changes apparent direction, swirls and fades as if carried on the mist. He use of sound fading, gives the illusion that the fog is dispersing. In conclusion, I feel Mallatratts play was a truly nerve-shredding experience. His use of lighting when the Woman in Black was on stage was classic. The experience made my skin crawl and my hair stand on end. The sound created an atmosphere of terror, the most effective scene was the sound used to recreate the ponys hooves. Mallatratt truly made me feel that a horse and carriage was entering the stage through the sounds effects. However, I feel he could have used more props to give more effect. An example includes a silhouette of the little boy. By using three actors Mallatratt has still captures Kipps story. I suggest that due to his precise and detailed stage directions any other director could be re-capture the essence of his play. Overall, I found the theatre experience far better than reading the play due to being part of the atmosphere.