Construction of an Islamic Center near Ground Zero Essay

The approval by the authorities in the United States to build an Islamic cultural center at a location near the spot of the September the eleventh attacks in America resulted in a controversy that touched on the basic rights of Americans protected by the first amendment of the American constitution. The Commission for Landmark Preservation in New York approved the construction of the Islamic center just two blocks away from the site of the World Trade Center because the two buildings torn apart to give way for the construction of the Islamic center were not very distinctive landmarks in Manhattan (Aljazeera). This decision proved to be divisive to the American public because it degenerated quickly into a national debate and a†¦show more content†¦It also touched on the unique history of the ground zero as well. For example, many Americans who opposed the construction of the Islamic center yet they are supporters of freedom of religion. For The people who lost their friends and relatives in the September, the 11 attacks, their wounds were still hurting in them and they could not tolerate anything close to the site because ground zero is the only cemetery they have for their dead relatives (Gladstone). The construction of a Muslim center close to the site represented an abomination to them because it symbolized the triumph of radical Islam in America (McFarland). This emotional dimension of opposing the construction of the mosque provides some validity in some of the arguments for the opponents of the construction of the mosque at a location near the site of the September the eleve nth attacks in lower Manhattan in New York. The first falsehood Perpetuated by the media that resulted in the explosive nature of the debate is that the Islamic center was being built at ground zero, the site of the former World Trade Center building. This was not correct because the area approved for construction of the Islamic center is a building that used to serve as a factory for Burlington coats two blocks away from the site of the World Trade Center (Gladstone). This was a lie perpetuated by the media and some people opposed to the construction of the Islamic center used to exploit and manipulate the emotionsShow MoreRelatedThe Ground Zero Mosque: An Insult to America Essay1040 Words   |  5 Pagesmillions forever and is once more a resurfacing issue. On this horrendous date in time, Islamic terrorists hijacked a pair of commercial airplanes and flew them into the Twin Towers, murdering thousands and causing millions in damage. Nearly a decade later, an Islamic religious gr oup named the Cordoba Initiative is stirring up more trouble and is planning to construct a mosque within only blocks away from ground zero itself. 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Attention Deficit Hyperactivity Disorder ( Adhd ) - 961 Words

ADHD can affect a Child’s Success in School Attention Deficit Hyperactivity Disorder (ADHD) has three primary symptoms of: inattention, hyperactivity, and impulsivity. Children with ADHD have difficulties in everyday life, whether it be in school or at home. They tend to be misunderstood by others. Children with ADHD have a much more difficult time learning than traditional students. Children with ADHD struggle to be successful in school. In most schools, the environment is not designed to meet the needs of students with ADHD. Jean Segal, Ph.D. is the Editor-in chief of Help Guide and a Sociologist Psychologist with 40 years of experience as an innovator within the fields of emotions, intelligence, holistic health, and relationships. Melinda Smith, MA is the senior editor of Help Guide. She has a degree in Psychology and over 15 years of experience as a health writer and editor. According to Jeanne Segal and Melinda Smith, â€Å"The classroom environment can be a challenging place for a child with ADD/ADHD. The very tasks these students find the most difficult-sitting still, listening quietly, concentrating-are the ones they are required to do all day long. Perhaps most frustrating of all is that most of these children want to be able to learn and behave like their unaffected peers. Neurological deficits, not unwillingness, keep kids with attention deficit disorder from learning in traditional ways.† Because AD HD bad negative effect, children with ADHD face encounter moreShow MoreRelatedAttention Deficit Hyperactivity Disorder ( Adhd )1710 Words   |  7 Pages Attention-deficit hyperactivity disorder or ADHD which is often referred to as childhood hyperactivity, it s a severe and chronic disorder for children. It is one of the most prevalent childhood disorders, and affects 3% to 5% of the school-age population. Boys outnumber girls three or more to one. Children with ADHD can experience many behavioral difficulties that often manifest in the form of inattention, being easily distracted, being impulsive, and hyperactivity. As a result, children withRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1744 Words   |  7 PagesI chose to research Attention-Deficit Hyperactivity Disorder, otherwise known as ADHD, in culture and child development for the following reasons. First, it is important as educators that we understand the difference between restlessness and Attention-Deficit Hyperactivity Disorder in children. Secondly, we must be conscious of the origins of ADHD, how to recognize it, the myths and prejudices against it, and kn ow the most appropriate intervention strategies. Educators must also realize that evenRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1002 Words   |  5 PagesAbstract There are many disorders that are first diagnosed whether it is during infancy, childhood or adolescence. The disorders range from intellectual disabilities, learning disabilities, communication disorders, all the way through to elimination disorders. Attention-deficit and disruptive disorders are the most common. All including AD/HD, conduct disorder, oppositional defiant disorder, and unspecified disruptive disorder. Attention deficit hyperactivity disorder is one of the most commonRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1495 Words   |  6 Pagesoccasionally forget to do their homework, get fidgety when they lose interest in an activity, or speak out of turn during class time. But inattentiveness, hyperactivity, and impulsivity are all signs of attention deficit hyperactivity disorder (ADHD). ADHD is a neuro-development disorder and can start as early as three years old throughout adulthood. People with ADHD have trouble focusing on tasks and activities, this c an have a negative impact on the individual in different ways. It can make the child feelRead MoreAttention Deficit / Hyperactivity Disorder ( Adhd )1699 Words   |  7 Pageshas had some difficulty sitting still, paying attention and even controlling impulsive behavior once or twice in our life. For some people, however, the problems that occur slim to none in our life occurs in the lives of theirs every day and interfere with every aspect of their life inclusive of home, academic, social and work. . The interaction of core ADHD symptoms with co-morbid problems and neuropsychological deï ¬ cits suggests that individuals with ADHD are likely to experience problems in academicRead MoreAttention Deficit Hyperactivity Disorder (ADHD)1259 Words   |  5 PagesAttention Deficit Hyperactivity Disorder (ADHD) is the most commonly found disorder in children in the United States. Statistics show that the male to female ratio for children with ADHD is eight to one. 4.4 million Children be tween the ages four to seventeen have diagnosed with ADHD (Cheng Tina L et al.). African American children are at a higher risk for having ADHD. Caucasian children are least likely to have ADHD. 2.5 million children receive medication for ADHD, but African American childrenRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1058 Words   |  5 Pagesfrom disorders such as Attention Deficit Hyperactivity Disorder (or ADHD/ADD.) While much is known about these disorders and how they affect the education of children, there are only a few known methods that consistently help an affected child focus and target in on what they need to learn. Medication for children With Attention Deficit (Hyperactivity) Disorder must be used as an aid to help the affected child to focus and comprehend information being presented to them. Children with Attention DeficitRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1552 Words   |  7 PagesATTENTION DEFICIT HYPERACTIVITY DISORDER Seth was a second grader at West Elementary. He constantly got reprimanded by his teachers for not paying attention in class. He could not understand the information given to him during the school day. He thought he was stupid and useless. But he was not. His parents got him tested by a doctor for ADHD. He is one of many kids in the United States who have been recognized as having it. Attention Deficit Hyperactivity Disorder is a major issue in the educationRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )978 Words   |  4 Pagesin diagnoses of attention deficit hyperactivity disorder (ADHD) in children since the 21st century. Per the Centers for Disease Control and Prevention the increase has been seen as a difference from, â€Å"7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011† (p. 4). Many questions arise concerning why the numbers are on the rise, especially when boys are 7.6 percent more likely than girls to receive the diagnosis of ADHD. When should the line be drawn between a disorder, and hyperactivity that comes withRead MoreAttention Deficit Hyperactivity Disorder ( Adhd ) Essay700 Words   |  3 PagesWhat is ADHD? Attention Deficit Hyperactivity Disorder (ADHD) affects almost 10% of American children between 13 and 18 years old, as well as 4% of U.S. adults over 18. Only a licensed mental health professional can provide an ADHD diagnosis, after a thorough evaluation. ADHD has three primary characteristics: Inattention, hyperactivity and impulsivity. Inattentive: Are effortlessly distracted, fail to catch details, are forgetful, and regularly switch activities. Find it difficult to focus

Case Study †Appendicitis Free Essays

I. DEFINITION/PREVALENCE Acute disease of the GI tract may be caused by the pathogen itself or by a bacterial or other toxin. Acute inflammatory disorders such as appendicitis and peritonitis result from contamination of damaged or normally sterile tissue by a client’s own endogenous or resident bacteria (Lemone and Burke, 2008, page 766). We will write a custom essay sample on Case Study – Appendicitis or any similar topic only for you Order Now Appendicitis is the inflammation of the vermiform (wormlike) appendix; the appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve, which is the beginning of the large intestine. It is usually located in the right iliac region, at an area designated as McBurney’s point. McBurney’s point, located midway between the umbilicus and the anterior iliac crest in the right lower quadrant. It is the usual site for localized pain and rebound tenderness due to appendicitis during later stages of appendicitis. The function of the appendix is not fully understood, although it regularly fills and empties digested food. Some scientists have recently proposed that the appendix may harbor and protect  bacteria  that are beneficial in the function of the human colon. Appendicitis  is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. The lower quadrant pain is usually accompanied by a low-grade fever, nausea, and often vomiting. Loss of appetite is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burney’s point applied located at halfway between the umbilicus and the anterior spine of the Ilium. Rebound tenderness (ex. Production or intensification of pain when pressure is released) may be present. The extent of tenderness and muscle spasm and the existence of the constipation or diarrhea depend not so much on the severity of the appendiceal infection as on the location of the appendix. If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. Rovsing’s sign may be elicited by palpating the left lower quadrant. If the appendix has ruptured, the pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patient’s condition worsens. The disease is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates. It is the most common reason for emergency abdominal surgery, affecting 10% of the population. Although appendicitis affects a person at any age, the peak incidence is between the ages of 20 and 30 years old in which the vast majority of clients are most common in adolescents and young and slightly more common in males than females. About 7% of the population will have appendicitis at some time in their lives (Lemone and Burke, 2008 page 766). The major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal Pyle phlebitis, which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines. Perforation generally occurs 24 hours after the onset of pain symptoms include a fever of 37. 7 degree Celsius or 100 degree Fahrenheit or greater, a toxic appearance and continued abdominal pain or tenderness. II. TYPES/CLASSIFICATION Appendicitis can be classified as simple, gangrenous, or perforated, depending on the stage of the process. In simple appendicitis, the appendix is inflamed but intact. When areas of tissue necrosis and microscopic perforations are present in the appendix, the disorder is called gangrenous appendicitis. A perforated appendix shows evidence of gross perforation and contamination of the peritoneal cavity (LeMone Burke, 2008 page 766). Peritonitis can be primary or secondary. Primary peritonitis is an acute bacterial infection that is not associated with perforated viscus, or organ. Bacterial infection is the usual cause and may be associated with an infection by the same organism somewhere else in the body, which reaches the peritoneum via the vascular system. Tuberculosis peritonitis, which originates from tuberculosis elsewhere in the body, is a type of primary peritonitis. Clients with alcoholic cirrhosis and ascites, in the absence of a perforated organ, often manifest peritonitis, which may be due to leakage of bacteria through the wall of the intestine. Secondary peritonitis is usually caused by bacterial invasion as a result of perforation, or rupture of an abdominal viscus. It can also result from severe chemical reactions to: pancreatic enzymes, digestive juices, or biles released into the peritoneal cavity (Gould Dyer, 2011). III. DEMOGRAPHIC PROFILE Patient’s name is Mr. Ruptured Acute Appendicitis, 24 years old, male, residing at 820 General Kalentong, Daang Bakal, Mandaluyong City. He is the second child among 3 siblings, a Roman Catholic, single, a 3rd year college Information Technology student. IV. FAMILY MEDICAL HISTORY (Family Genogram)COD: TB COD: TB A: 83 -S, -D A: 83 -S, -D Not Recalled Not Recalled c c A: 20 +S, +D A: 20 S, +D A: 24 +S, +D A: 24 +S, +D A: 27 -S, -D Skin allergy A: 27 -S, -D Skin allergy A: 42 +S, +D A: 42 +S, +D A: 64 +S, +D HPN, Stroke A: 64 +S, +D HPN, Stroke c c A: 46 -S, +D Asthma A: 46 -S, +D Asthma A: 51 -S, +D A: 51 -S, +D patient patient LEGEND: LEGEND: male male married married deceased male deceased male S- smoker D- drinker COD- cause of death S- smoker D- drinker COD- cause of death female female deceas ed female deceased female V. PAST MEDICAL HISTORY He was first hospitalized last 2006 due to dengue at the same hospital: Mandaluyong City Medical Center (MCMC). He has no other further illnesses except the typical fever, cough and cold. Other than that, he has no allergies, hypertension, or diabetes mellitus. VI. HISTORY OF PRESENT ILLNESS 1 week prior to admission patient experienced abdominal pain all over abdomen. He consulted at ER MCMC signed out AUPD (Acute Peptic Ulcer Disease) and was given Omeprazole HNBB (Buscopan). Whole abdominal ultrasound done and revealed tiny cholecystolethiasis. He was given Diclofenal and HNBB tab and eventually discharged. Few days prior to consultation, the patient still experienced abdominal pain. He consulted at Emergency Room and was opted for surgical intervention – EXPLORATORY LAPAROTOMY APPENDECTOMY under the service of Dr. Abram Del Valle, M. D. VII. GORDON’S PHYSICAL ASSESSMENT i. Health Maintenance – Perception Pattern Before admission: The patient used to smoke cigarette 3 sticks per day. And he also drinks alcohol daily specifically beer of more than 2 bottles per session. He was not using drugs and he has no allergies at all. During time of care: The patient is not smoking cigarette or drinking alcohol. ii. Nutritional – Metabolic Pattern Before admission: The patient was on a high protein diet because he was used to go to the gym 2-3 times a week. He was also taking vitamins (CENTRUM). He has normal appetite and has no difficulty swallowing. He usually eats 3 times a day (breakfast, lunch and dinner) and most of the time he also has his snacks. He also usually drinks 2-3 liters of water a day. e During time of care: The patient is on NPO (nothing per orem) for 5 days due to post-operative appendectomy and he was on his 2nd day of NPO status when we cared for him. He has also NGT lavage connected. ii. Elimination Pattern Before admission: The patient’s normal bowel movement was 3 BM a day and has no difficulty in bladder habits. His last bowel movement was last July 17, 2012. He usually urinates 6-7 times a day without difficulty. During time of care: The patient has absence of bowel movement and even flatus and has no bowel sounds upon auscultation. He has foley catheter and with urine output of 480 cc per shi ft. iv. Activity and Exercise Before admission: The patient could do his activities independently without assistance. He usually goes to gym 2-3 times a week. During time of care: The patient’s functional level or self-care ability level is 2 which mean he requires help from another person for assistance. v. Sleep/Rest Pattern Before admission: The patient usually sleeps at 4 or 5 am and wakes up at 8 or 9 am. He has no difficulty in sleeping and he feels rested after sleep. During time of care: The patient has regular sleeping habits. He sleeps at 10 am, wakes up at 6 am with uninterrupted sleep. vi. Cognitive – Perceptual Pattern Before admission: The patient was alert and coherent, has normal speech, with mild level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. During time of care: The patient is alert and coherent. He has normal speech (Filipino as his spoken language), he has moderate level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. He also complained of acute pain and described it as a cramping pain. Pain management (Tramadol) was given. vii. Role – Relationship Pattern Before admission: The patient was a student and single. His support system was his family, relatives friends. During time of care: The patient’s support system is his mother who is always at his bed side assisting him in whatever he needs. Upon asking his mother if she has any concerns regarding hospitalization, she said that she is more concern about the fast recovery of her son. viii. Sexuality – Reproductive System Before admission and during the time of care: The patient still didn’t have his testicular exam. ix. Coping – Stress Tolerance/Self – Perception/Self – Concept Pattern The patient’s major concern regarding his hospitalization is s all about self-care. Due to the contraptions attached to him, he cannot independently do his activities. His major loss was his stepfather when he died of kidney failure. His rated his outlook on future as 5, 1 being poor and 10 being very optimistic. He further explained why he rated 5 because he is not sure if when he finished college he can be able to find a job suited for him. x. Value – Belief Pattern Our patient is a Roman Catholic and he always goes to church every Sunday together with his family. VIII. GROWTH AND DEVELOPMENT DEVELOPMENTAL TASK| THEORIST| STATUS| Intimacy vs. Isolation * Develops commitments to others and to a life work (career)(Daniels, et. al. , 2010). | Erikson| The patient had a relationship with his opposite sex but he said that they just broke up a week before he was hospitalized due to some personal and private reasons. Currently, he is in 3rd year college, an IT student. | Genital * Emergence of sexual interests and development of relationships with potential sexual partners (Daniels, et. al. , 2010). | Freud| As what had written above, the patient had a relationship with his opposite sex but because of some reasons they decided to end up their relationship. Formal Operations * Able to see relationships and to reason in the abstract (Daniels, et. al. , 2010). | Piaget| He perceived that relationships (any kind of relationship) are important especially at his age. He can also reason out in an abstract way. He can express his opinions intellectually and precisely. | Early Adulthood * Select a partner, learn to live with a partner, s tart a family, manage a home, establish self in a career/occupation, assume civic responsibility, and become a part of a social group (Daniels, et. al. , 2010). Havighurst| According to our patient, he didn’t expected that something like that will happen to them (referring to his girlfriend). He was really expecting that they are really meant for each other and that she (his gf) will be his future wife. He is also establishing himself to a future career, that’s why he is studying in preparation for his future. During our time of care also, his ‘barkadas’ visited him and he said that they were his ‘tropa’. | Postconventional * Individual understands the morality of having democratically established laws (Daniels, et. al. , 2010). Kohlberg| Upon asking the patient if he is familiar with the democratically established laws in the Philippines, he immediately responded with a yes. He also said that these laws help us, Filipinos, to have safe and se cure country though there may come a time that we may experience something unexpectedly. | IX. PHYSICAL ASSESSMENT * Vital Signs TIME| Initial 8AM (07/24/12)| 10 AM| 12 NN| 8 AM (07/25/12)| 12 NN| Last 8AM(07/26/12)| T| 36. 3| 37. 3| 37. 4| 36. 4| 37. 3| 36| P| 83| 84| 71| 75| 81| 68| R| 23| 25| 21| 19| 19| 20| BP| 120/80| 120/80| 120/80| 120/80| 120/80| 110/80| Sequence: BY SYSTEMS NORMAL FINDINGS| BOOK FINDINGS| PATIENT FINDINGS| SIGNIFICANCE| I. NEUROLOCIGAL SYSTEM Alert and coherent; with normal body temperature of 36. 3 °C – 37. 6 °C| * Fever (usually 38 °C although hypothermia may be present w/ severe sepsis); chills * Thirst * Pain| * Complained of pain in the incision site (lower longitudinal midline of the abdomen)| Pain results from the increased pressure of fluid on the nerves, especially in enclosed areas, and by the local irritation of nerves by chemical mediators such as bradykinins (Gould, et al. 2011). | II. RESPIRATORY Normal respiration with a rate of 12-20 breaths per minute| * Tachypnea; shallow respirations| * RR: 23 bpm w/ shallow respiration| Acute pain usually initiates physiologic stress response with increased respiratory rate (Gould Dyer, 2011). | III. INTEGUMENTARY Pink or brown and in uniform color, no edema, no lesions, moistSkin temperature is normally warmIntact skinWhen pinched, skin springs back to previous state| * Dry lips and mucous membranes * Swollen tongue * Poor skin turgor| * Dry lips and mucous membranes * Skin turgor:3-5 seconds * Presence of surgical incision at lower longitudinal midline of the abdomen * Skin is warm to touch and is reddened| Dry mucous membrane and poor skin turgor are signs of dehydration (Gulanick, et al. 1994). Redness may indicate inflammation (Weber Kelly, 2007). Redness and warmth are caused by increased blood flow into the damaged area (Gould Dyer, 2011). | IV. CARDIOVASCULAR Normal pulse rate of 60-100 bpm| * Tachycardia * Diaphoresis * Pallor * Hypotension * Tissue edema| * Pulse rate: 83 bpm| Acute pain usually initiates a physiologic stress response with increased heart rate (Gould Dyer, 2011). | V. MUSCOLOSKELETAL Ability to do Activities of Daily Living (ADL)| * Difficulty ambulating * Weakness| * Difficulty ambulating due to post-op condition * Weakness| Constant pain frequently affects daily activities and may become a primary focus in the life of an individual (Gould Dyer, 2011). | VI. GENITO-URINARY Normal urine output of 30cc/hrColor: Amber, transparent, clear| * Decreased urinary output * Dark color urine| * Dark color urine * Urine output: 480 mL/shift * Specific gravity: 1. 30| Decreasing output of concentrated urine with increasing specific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). | VII. GASTROINTESTINAL Abdominal skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elementsAbdomen is free of lesions or rashesA series of intermittent, soft clicks and gurgles are heard at a rate of 5-30 per minuteNormally no tenderness or pain is elicited or reported by the clientNo rebound tenderness is presentAbdo men is non-tender and soft. There is no guarding| * Loss of appetite * Nausea vomiting(usually projectile) * Constipation of recent onset * Diarrhea(occasional) * Sudden, severe, generalized abdominal pain * Abdominal distention; rigidity * Decreased/absence of bowel sounds * Inability to pass stool/flatus * Muscle guarding (abdomen) * Psoas’ Sign (flexion of or pain on hyperextension of the hip due to contact between an inflammatory process the psoas muscle) * Obturator Sign (the internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee and a resultant tightening of the internal obturator muscle may ause abdominal discomfort) * Rovsing’s Sign (pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant) * Rebound tenderness (a sign of inflammation of the peritoneum in which pain is elicited by the sudden release of the fingertips pressing on the abdomen) | * Board-like abdomen * Sudden, severe, generalized abdominal pain * Absence of bowel sounds in all four quadrants * Absence of flatus/stool * Presence of surgical incision| Signs indicating the onset of peritonitis include a rigid â€Å"board-like† abdomen (Gould Dyer, 2011). Pain recurs as a steady, severe abdominal pain as peritonitis develops (Gould Dyer, 2011). Absence of bowel sounds may be associated with peritonitis or paralytic ileus (Weber Kelly, 2007). When inflammation persists, nerve conduction is impaired, and peristalsis decreases, leading to obstruction of the intestines (paralytic ileus) (Gould Dyer, 2011). | X. DIAGNOSTIC TESTS DIAGNOSTIC TEST| NORMAL| RESULT| SIGNIFICANCE| WHOLE ABDOMINAL ULTRASOUND (July 21, 2012) | The organs examined appear normal (Cosgrove, et al. , 2008). | Liver is not enlarged. It has homogenous echopattern with smooth border. The intrahepatic ducts are not dilated. No evident focal mass lesion seen. CD measures 3. 9mm. Gallbladder is normal in size and wall thickness. There are multiple tiny echogenic shadowing foci seen within the gallbladder lumen. Pancreas spleen are normal in size echopattern. No focal mass lesion seen. Both kidneys are normal in size echopattern. Right kidney measures 10. 1Ãâ€"4. 2Ãâ€"5. 46cm with cortical thickness of 1. 7cm while the left kidney measures 10. 5Ãâ€"4. 8Ãâ€"4. 1cm with thickness of 19cm. No evident caliectasis, lithiasis, seen bilaterally. Urinary bladder is unfilled. Impression:Tiny cholecystolithiasesNormal liver, pancreas, spleen, kidneys by UTZUnfilled urinary bladderNot dilated biliary tree | Abdominal ultrasound is the most effective test for diagnosing acute appendicitis (LeMone Burke, 2007). | HEMATOLOGY REPORT/COUNT (July 21, 2012)| RBC: 4. 2-5. 6 M/uLPlatelets: 150-400 x 10/LWBC: 3. 8-11. 0 K/mm3Hemoglobin: 135-180g/LHematocrit: 0. 45-0. 52DifferentialNeutrophils: 0. 50-0. 81Lymphocytes: 0. 14-0. 44Monocytes:0. 02-0. 06Eosinophils: 0. 01-0. 05Basophils:0. 00-0. 01| WBC Count: 12. 6 K/mm3RBC: 4. 1 M/uL (normal)Hematocrit: 0. 45 (normal)Hemoglobin: 153g/L (normal)Differential Count:Neutrophils 0. 90Lymphocytes 0. 10 (normal)| Elevated WBC is seen in acute infection (LeMone Burke, 2007). Neutrophils: elevated in bacterial infection (LeMone Burke, 2007). | URINALYSIS (July 21, 2012)| Color: Light straw to amber yellowAppearance: ClearOdor: AromaticpH: 4. 5-8. 0Specific gravity: 1. 005-1. 030Protein: 2-8mg/dLGl ucose: NegativeKetones: NegativeRBCs: RareWBCs: 3-4Casts: Occasional hyaline| Color: Dark YellowTransparency: TurbidUrine pH: 6. 0 Specific gravity: 1. 30Sugar: NegativeProtein: +4Microscopic examPus cells 4-6/HPFRBC 1-2/HPFCrystals: Amorphous Sulfate Moderate| A dark yellow to brownish color is seen with deficient fluid volume (LeMone Burke, 2007). Hazy or cloudy urine indicates bacteria, pus, RBCs, WBCs, phosphates, prostatic fluid spermatozoa, or urates (LeMone Burke, 2007). | CLINICAL CHEMISTRY (July 21, 2012)| Sodium (Na): 135-142 mmol/LPotassium (K): 3. 8-5 mmol/L| Sodium: 132 mmol/LPotassium: 4. 02 mmol/L| Sodium is decreased in SIADH vomiting (LeMone Burke, 2007). | XI. ANATOMY PHYSIOLOGY OF APPENDIX (LARGE INTESTINE) The large intestine, which is about 1. 5 m (5 ft) long and 6. 5 cm (2. 5 in. ) in diameter, extends from the ileum to the anus. It is attached to the posterior abdominal wall by its mesocolon, which is a double layer of peritoneum. Structurally, the four major regions of the large intestine are the cecum, colon, rectum, and anal canal. The opening from the ileum into the large intestine is guarded by a fold of mucous membrane called the ileocecal sphincter (valve), which allows materials from the small intestine to pass into the large intestine. Hanging inferior to the ileocecal valve is the cecum, a small pouch about 6 cm (2. 4 in. ) long. Attached to the cecum is a twisted, coiled tube, measuring about 8 cm (3 in. ) in length, called the appendix or vermiform appendix (vermiform = worm-shaped; appendix = appendage). The mesentery of the appendix, called the mesoappendix, attaches the appendix to the inferior part of the mesentery of the ileum. The open end of the cecum merges with a long tube called colon, which is divided into ascending, transverse, descending colon are retroperitoneal; the transverse and sigmoid colon ascends on the right side of the abdomen, reaches the inferior surface of the liver, and turns abruptly to the left to form the right colic (hepatic) flexure. The colon continues across the abdomen to the left side as the transverse colon. It curves beneath the inferior end of the spleen on the left side as the left colic (splentic) flexure and passes inferiorly to the level of the iliac crest as the descending colon. The sigmoid colon begins near the left iliac crest, projects medially to the midline, and terminates as the rectum at about the level of the third sacral vertebra. The rectum, the last 20 cm (8 in. ) of the GI tract, lies anterior to the sacrum and coccyx. The terminal 2-3 cm (1 in. ) of the rectum is called the anal canal. The mucous membrane of the anal canal is arranged longitudinal folds called anal columns that contain a network of arteries and veins. The opening of the anal canal to the exterior, called the anus, is guarded by an internal anal sphincter of smooth muscle (involuntary) and an external anal sphincter of the skeletal muscle (voluntary). Normally these sphincters keep the anus closed except during the elimination of feces (Tortora Derrickson, 2006). XII. PATHOPHYSIOLOGY NARRATIVE Appendicitis, inflammation of the vermiform appendix, is a common cause of acute abdominal pain. It is the most common reason for emergency abdominal surgery, affecting 10% of the population (Tierney et al. , 2005). Appendicitis can occur at any age, but is more common in adolescents and young adults and slightly more common in males than females (LeMone Burke, 2007). The development of appendicitis usually follows a pattern that correlates with the clinical signs, although variations may occur because of the altered location of the appendix or underlying factors (Gould Dyer, 2011). Obstruction of the proximal lumen of the appendix is apparent in most acutely inflamed appendices. The obstruction is often caused by fecalith, or hard mass of feces. Other obstructive causes include a calculus or stone, a foreign body, inflammation, a tumor, parasites (e. g. , pinworms), or edema of lymphoid tissue (LeMone Burke, 2007). Following obstruction, the appendix becomes distended with fluid secreted by its mucosa and microorganisms proliferate. Pressure within the lumen of the appendix increases, impairing its blood supply because blood vessels in the wall are compressed thus the appendiceal wall becomes inflamed and purulent exudate forms. Within 24 to 36 hours, the increasing congestion and pressure within the appendix leads to ischemia and necrosis of the wall, resulting in increased permeability. Bacteria and toxins escape through the wall into the surrounding are. This breakout of bacteria leads to abscess formation or localized peritonitis. An abscess may develop when the adjacent omentum temporarily walls off the inflamed area by adhering to the appendiceal surface. In some cases, the inflammation and pain subside temporarily but then recur. Localized infection or peritonitis develops around the appendix and may spread along the peritoneal membranes. Increasing pressure inside the appendix causes increased necrosis and gangrene in the wall (infection in necrotic tissue). The wall of the appendix appears blackish. The appendix ruptures or perforates, releasing its contents into the peritoneal cavity. This leads to generalized peritonitis and would lead to septicemia and into septic shock and will result to death (Gould Dyer, 2011). XIII. PATHOPHYSIOLOGY DIAGRAM Risk Factors Non-modifiable: * Age (Adolescents young adults) * Gender (Male) Modifiable: * Fecalith * Calculus/Stone * Foreign body * Inflammation * Tumor * Parasites Edema of lymphoid tissue Obstruction of the appendiceal lumen Obstruction of the appendiceal lumen Buildup of fluid inside the appendix Buildup of fluid inside the appendix Proliferation of microorganisms Proliferation of microorganisms Abdominal pain Abdominal pain Increased pressure within the lumen of appendix Increased pressure within the lumen of appendix Compression of blood vessels Compression of blo od vessels * Fever * Obturator Sign * Psoas Sign * Rovsing’s Sign * Rebound tenderness * Fever * Obturator Sign * Psoas Sign * Rovsing’s Sign * Rebound tenderness Decreased blood flow into the appendix Decreased blood flow into the appendix Inflammation of appendiceal wall Inflammation of appendiceal wall (July 21, 2012) Hematology Count * WBC count: 12. 6 K/mm * Neutrophils: 0. 90 Urinalysis * Transparency: turbid (July 21, 2012) Hematology Count * WBC count: 12. 6 K/mm * Neutrophils: 0. 90 Urinalysis * Transparency: turbid Ischemia necrosis of the wall Ischemia necrosis of the wall Increased permeability Increased permeability Bacteria and toxins escape through the wall Bacteria and toxins escape through the wall Abscess formation/localized bacterial peritonitis Abscess formation/localized bacterial peritonitis Proliferation of localized peritonitis around the appendix and peritoneal membranes Proliferation of localized peritonitis around the appendix and peritoneal membranes Increased pressure inside the appendix Increased pressure inside the appendix * Sudden, severe, generalized abdominal pain * Abdominal distention rigid â€Å"boardlike† abdomen * Absence of bowel sounds/(-) flatus/(-) BM (July 24, 2012) * Sudden, severe, generalized abdominal pain * Abdominal distention rigid â€Å"boardlike† abdomen * Absence of bowel sounds/(-) flatus/(-) BM July 24, 2012) Increased necrosis and gangrene in the wall Increased necrosis and gangrene in the wall Appendectomy with NGT lavage (July 22, 2012) Appendectomy with NGT lavage (July 22, 2012) Perforation of the appendix Perforation of the appendix Intestinal bacteria leak out into peritoneal cavity Intestinal bacteria leak out into peritoneal cavity * Low-grade fever leukocytosis * Tachycardia * Hypotension * Vomiting * Low-grade fever leukocytosis * Tachycardia * Hypotension * Vomiting Generalized peritonitis Generalized peritonitis XIV. NURSING PROCESS Problem #1: ABDOMINAL PAIN – July 24, 2012 * Subjective Cues: * â€Å"Nurse wait lang, ang sakit kasi parang nagcacramps,† patient verbalized while having a conversation with him. How does it feel like: Abdominal cramping Precipitating factor: â€Å"Kapag nililinisan pero kadalasan bigla-bigla na lang sumasakit† (â€Å"Whenever wound cleaning is performed but oftentimes it just suddenly happened†) Relieving factor: Pain reliever (but not all the time pain reliever is being given) Does it radiate to the other parts of the body (back, legs, chest, etc): No Duration of pain: â€Å"Paiba-iba din eh. Minsan sobrang tagal mga 2-3 minutes, minsan naman mga ilang Segundo lang† (â€Å"It differs, sometimes it’s too long (2-3 minutes) and sometimes it just happened for a second†) * Patient rated the pain as 8/10 where 0 signifies no pain and 10 signifies unbearable pain. * Objective Cues: * Facial grimace * Guarding of the incision site * Rigid (board-like) abdomen * Abdominal distention * Location of pain: Surgical site * RR: 25 bpm * Nursing Diagnosis Acute Pain related to inflammation of the tissues secondary to post-op surgical incision. Inflammation or nerve damage gives rise to changes in sensory processing at peripheral and central level with a resultant sensitization. In relation, prostaglandins are chemotactic substances drawing leukocytes to the inflamed tissue. It plays a vasoactive role; it is also a pain and fever inducer (Lemone and Burke, 2007). Acute Pain related to infection inflammation of the peritoneal membranes secondary to peritonitis The peritoneum consists of a large sterile expanse of highly vascular tissue that covers the viscera and lines of abdominal cavity. This peritoneal structure provides a mean of rapid dissemination of irritants or bacteria throughout the abdominal cavity. Abdominal distention is evident, and the typical rigid, board-like abdomen develops as reflex abdominal muscle spasm occurs in response to involvement of the parietal peritoneum (Gould Dyer, 2011). * Goal/NOC: Pain Control Outcomes Short Term: After 30 minutes of nursing intervention the patient will report a decrease in pain from pain scale of 8/10 to 4-5/10. Long Term: After 8 hours of nursing intervention the patient will demonstrate an understanding about the proper way of controlling pain as evidenced by proper splinting and deep breathing exercise and will report a decrease or most probably will be free from pain from pain scale of 4-5/10 to 1-2/10. * NIC: Pain Management Independent: * Assessed pain including its character, location, severity, and duration. Both preoperatively and postoperatively, the client’s pain provides important clues about the diagnosis and possible complications. Abdominal distention and acute inflammation contribute to the pain associated with peritonitis. Surgery further disrupts abdominal muscles and other tissues, causing pain (LeMone Burke, 2007). * Monitored vital signs every 2 hours. Vital Signs, especially respiratory rate (RR), are usually altered in acute pain. (Sparks and Taylor, 2005). * Kept the client at rest in semi-Fowler’s position. Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position (Doenges et al. , 2006). * Provided diversional activities (texting, sound trip, etc). Refocuses attention, promotes relaxation, and may enhance coping abilities and diverts attention from pain (Doenges et al. , 2006). * Taught post-op health teaching (e. g. , proper splinting deep breathing exercises). The use of non-invasive pain relief measures can increase the release of endorphins and enhance the therapeutic effects of pain relief medications (LeMone Burke, 2007). * Encouraged early ambulation. Promotes normalization of organ function; stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). Give hot and cold compress. Hot, moist compresses have a penetrating effect. The warm rushes blood to the affected area to promote healing. Cold compresses may reduce total edema and promote some numbing, thereby promoting comfort. (Doenges et al. , 2006). Dependent: * Administered analgesic as prescribed (TRAMADOL 50 mg/IV Q 8 ° x 3 doses) Time given: 8 AM. Post-operatively, analgesics are provided to maintain comfort and enhan ce mobility (LeMone Burke, 2007). * Kept on NPO. Decreases discomfort of early intestinal peristalsis and gastric irritation/vomiting (Doenges et al. 2006). * Evaluation Short Term: Goal partially met. After 30 minutes of nursing intervention the patient reported of a decrease in pain from a pain scale of 8/10 to 6/10 in which 4-5/10 was the expected outcome. Long Term: Goal met. After 8 hours of nursing intervention the patient displayed control of pain as evidence by deep breathing exercise and proper splinting. He also reported of a decrease in pain with a pain scale of 2/10 from 6/10. Pain reliever – TRAMADOL was given @ 8 am via IV. Problem #2: ABSENCE OF FLATUS– July 24, 2012 * Subjective Cues: â€Å"Nurse wait lang, ang sakit kasi parang nagcacramps (referring to abdominal cramping),† patient verbalized while having a conversation with him. * Pain scale of 8/10 * Objective Cues: * (-) Flatulence * (-) BM (Last BM was July 17, 2012) * Absence of bowel sou nds upon auscultation of all four quadrants * Nursing Diagnosis Dysfunctional gastrointestinal motility related to inflammatory process of peritonitis secondary to absence of flatulence. The inflammatory process of peritonitis often draws large amounts of fluid into the abdominal cavity and the bowel. In addition, peristaltic activity of the bowel is slowed or halted by the inflammation, causing paralytic ileus, impaired propulsion of forward movement of bowel contents (LeMone Burke, 2007). * Goal/NOC: Ambulation Outcomes Short Term: After 8 hours of nursing intervention the client will report/experience flatus and will understand and demonstrate the need for early ambulation following abdominal surgery. Long Term: After 2 days of nursing intervention the client will report/experience either flatus or bowel movement or both. * NIC: Impaction Management; Positioning Independent: * Assessed abdomen including all four quadrants noting character to determine increased or decreased in motility; Assessed for further abdominal tenderness auscultated for any abdominal sounds. To help identify the cause of the alteration and guide development of nursing intervention (Sabol Carlson, 2007). * Monitored and recorded (intake) and output every hour or 2 hours. Intake and output records provide valuable information about fluid volume status (LeMone Burke, 2007). * Encouraged early ambulation. Promotes normalization of organ function; stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). * Assisted in moving from side to side or up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. (Gulanick, et. al. , 1994). Dependent: * Administered antacid as ordered (RANITIDINE 50g/IV Q 12 °. Antacids either directly neutralize acidity, increasing the  pH, or reversibly reduce or block the secretion of acid by gastric cells to reduce acidity in the stomach (Gabriely, et al. 2008). * Evaluation Short Term: Goal partially met. After 8 hours of nursing intervention the patient didn’t experience flatus or even bowel movement but was able to have an understanding with regards to early ambulation as evidenced by letting his mother assist him in moving up in bed going to the chair but refused to walk because of complaint of ha ving a lot of contraptions attached to him which causes him to have difficulty in moving. Long Term: Goal met. After 3 days of nursing intervention the patient reported of a flatus for 3 times. Problem #3: RISK FOR DEHYDRATION – July 24, 2012 * Subjective Cue: * â€Å"Nanghihina na ako kasi limang araw ako hindi pwede kumain pati tubig bawal din kaya nagnunuyo na yung labi ko,† as verbalized by the patient. * Objective Cues: * NPO for 5 days * Dry mucous membrane * Dry lips * Capillary refill= 2 seconds * Skin turgor= 3-5 seconds * Urine output/shift= 480 mL * Urine color: Dark Yellow * Urine specific gravity: 1. 030 (Normal value: 1. 005-1. 030) * Absence of bowel sounds of all the four quadrants * (-) Flatus, (-) BM * BP: 120/80 mmHg * PP: 83 bpm * Nursing Diagnosis Risk for deficient fluid volume related to postoperative restriction secondary to NPO for 5 days Inflammation of the peritoneum with sequestration fluid and NPO status can lead to dehydration and electrolyte imbalance (Doenges, et al. , 2008). * Goal/NOC: Knowledge: Treatment Regimen; Hydration; Oral Hygiene; Tissue Integrity: Skin Mucous Membranes Outcomes Short Term: After 30 minutes of nursing intervention patient will have an understanding with regards to maintaining fluid balance as evidenced by willingness of following the prescribed regimen given by the medical staffs. Long Term: After 3 days of nursing intervention the patient will be able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor, stable vital signs, and individually adequate urine output. * NIC: Fluid Management; Fluid Monitoring; Vital Signs Monitoring Independent: * Monitored BP Pulse. Variations help identify fluctuating intravascular volumes, or changes in vital signs associated with immune response to inflammation (Doenges, et al. , 2006). * Inspected mucous membranes; assessed skin turgor and capillary refill. Indicators of adequacy of peripheral circulation and cellular hydration (Doenges, et al. 2006). * Monitored intake and output; noted urine color/concentration, specific gravity. Decreasing urine output of concentrated urine with increasing specific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). * Auscultated bowel sounds. Noted passing of flatus, bowel movement. Indicators of return of peristalsis, readiness to begin oral intake (Doenges, et al. , 2006). * Provide clear liquids in small amounts when oral intake is resumed, and progress diet is tolerated. Reduces risk of gastric irritation/vomiting to minimize fluid loss (Doenges, et al. 2006). * Stressed the importance of having him on a NPO status and provided the necessary information with regards to his condition and the medications being administered (e. g. , IVF). It provides the patient a full understanding with regards to his condition thus encouraging him to participate and work hand in hand with the staff (Gulanick, et al. , 1994). * Gave frequent mouth care with special attention to protection of the lips. Dehydration results in drying and painful cracking of the lips and mouth (Doenges, et al. , 2006). Dependent: * Maintained gastric suction as indicated. Although not frequently needed, an NG tube may be inserted preoperatively and maintained in immediate postoperatively phase to decompress the bowel, promote intestinal rest, and prevent vomiting (Doenges, et al. , 2006). * Administered IV fluids (D5LR 1L x 8 ° or 30 gtts/min) and electrolytes (D5 Balanced Multiple Maintenance Solution w/ 5% dextrose 1L x 8 ° or 30 gtts/min). The peritoneum reacts to irritation/infection by producing large amounts of intestinal fluid, possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances (Doenges, et al. , 2006). * Evaluation Short Term: Goal met. After 30 minutes of nursing intervention the patient was able to have a full understanding with regards to maintaining fluid balance as evidenced by verbalizing, â€Å"So kaya pala hindi pa ako pwede kumain ngaun para maiwasan mairritate ang tiyan ko. † Long Term: Goal met. After 3 days of nursing intervention the patient was able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor (1-2 seconds), stable vital signs (please see page __ ), and adequate urine output of 620 mL with an appearance of amber yellow. Problem #4: RISK FOR INFECTION – July 24, 2012 Subjective Cues: â€Å"Nurse, sobrang kailangan ba talaga ang paghuhugas ng kamay bago linisan o hawakan sugat niya? †, asked by the mother. * Objective Cues: * Post-operative condition – presence of surgical incision * Surgical site is warm to touch and reddened * Temp: 36. 3 °C * Nursing Diagnosis Risk for infection related to inadequate prim ary defenses secondary to post-operative surgical incision It is risk to be invaded by pathogens especially if surgical site is near at the perineal area, pathogens can also develop by poor personal hygiene and poor wound cleaning (Doenges, et al. 2006). * Goal/NOC: Risk Control (For Infection) Outcomes Short Term: After 30 minutes of nursing intervention the patient will be able to have partial understanding about infection control and will verbalize understanding of and willingness to follow up prescribed regimen. Long Term: After 3 days of  nursing intervention  the  patient will be free of sign and symptom r/t infection. * NIC: Incision Site Care; Infection Control; Wound Care Independent: * Monitored vital signs. Noted onset of fever, chills, diaphoresis, changes in mentation, and reports of increasing abdominal pain. Suggestive of presence of infection/developing sepsis, abscess, peritonitis (Doenges, et al. , 2006). * Inspected incision and dressings. Noted characteristics of drainage from wound/drains, presence of erythema. Provides for early detection of developing infectious process, and/or monitors resolution of preexisting peritonitis (Doenges, et al. , 2006). * Instructed proper hand washing. Practiced aseptic wound care. Reduces risk for infection (Doenges, et al. , 2006). * Encouraged adequate nutritional intake after the NPO status of the patient and when the patient is allowed to eat. Adequate intake of protein, Vitamin C and minerals is essential to promote tissue and wound healing (Sparks and Taylor, 2005). Dependent: * Administered antibiotics (CEFUROXIME 750mg TID Q 8 ° x 2 doses METRONIDAZOLE 500g/IV Q 8 ° x 2 doses) as ordered. Therapeutic antibiotics are given if the appendix is ruptured or abscessed or peritonitis has developed (Doenges, et al. , 2006). * Prepare for/assist with incision and drainage (ID) if indicated. May be necessary to drain contents of localized abscess (Doenges, et al. , 2006). * Evaluation Short Term: Goal met. After 30 minutes of nursing intervention the patient was able to have an understanding about infection control as evidenced by verbalizing, â€Å"Para maiwasan ang pagkaroon ng impeksyon kailangan kong maghugas ng kamay palagi at kinakailangan din ang araw-araw na paglilinis ng sugat ko kahit na sa tuwing nililinisan ito makirot sa pakiramdam. † Long Term: Goal met. After 3 days of  nursing intervention  the  patient was free of sign and symptom r/t infection. Problem #5: INABILITY TO PERFORM ACTIVITY/IES OF DAILY LIVING (ADL) – JULY 24, 2012 * Subjective Cues: â€Å"Hirap talaga ako gumalaw, maglakadlakad, o kahit man lang umupo dahil sa mga nakakabit na ito sa akin,† as verbalized by the patient. â€Å"Nakakapanghina pa kasi masakit nga yung tahi tapos madalas din nagcacramps ang tiyan ko,† he added. * Objective Cues: * Presence of surgical incision * Presence of contraptions (urinary catheter, NGT lavage IV fluid @ left hand) * Nursing Diagnosis Impaired physical mobility related to body weakness, presence of surgical incision, pain, presence of contraptions attached Physical immobility can be usually associated with post-operative conditions (Gulanick, et al. 1994). * Goal/NOC: Activity Tolerance Outcomes Short Term: After 30-45 minutes of nursing intervention the patient will be able to have a clear understanding with the use of identified techniques to enhance activity tolerance and to apply it as well as evidenced by participating in ROM exercises, lower leg ankle exercise, ambulation, or even moving up in bed. Long Term: After 2-3 days of nursing intervention the patient will be able to continually participate in a simple form of activity and will report an improvement with regards to his activities. * NIC: Exercise Therapy: Balance Independent: * Performed passive ROM exercises. ROM exercises and good body mechanics strengthen abdominal muscles and flexors of spine (Gulanick, et al. , 1994). * Encouraged lower leg and ankle exercises. Evaluated for edema, erythema of lower extremities, and calf pain or tenderness. These exercises stimulate venous return, decrease venous stasis, and reduce risk of thrombus formation (Gulanick, et al. , 1994). * Noted emotional and behavioral responses to immobility. Provided diversional activities. Forced immobility may heighten restlessness and irritability. The Cardiovascular System iframe class="wp-embedded-content" sandbox="allow-scripts" security="restricted" style="position: absolute; clip: rect(1px, 1px, 1px, 1px);" src="https://phdessay.com/the-cardiovascular-system-intrinsic-conduction-system/embed/#?secret=fKNLnNlg3O" data-secret="fKNLnNlg3O" width="500" height="282" title="#8220;The Cardiovascular System#8221; #8212; Free Essays - PhDessay.com" frameborder="0" marginwidth="0" marginheight="0" scrolling="no"/iframe Diversional activity aids in refocusing attention and enhances coping with actual and perceived limitations (Gulanick, et al. , 1994). * Assisted with activity, progressive ambulation, and therapeutic exercises. Activity depends on individual situation. It should begin as early as possible and usually progresses slowly, based on client tolerance (Gulanick, et al. , 1994). * Assisted in moving from side to side or up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. Gulanick, et al. , 1994). * Noted client reports of weakness, fatigue, pain and difficulty accomplishing tasks. Symptoms may be result of/or contribute to intolerance of activity (Gulanick, et al. , 1994). Dependent: * Administered pain medication (TRAMADOL 50 mg/IV Q 8 ° x 3 doses, time given: 8 AM) as prescribed and on a regular schedule. Client’s anticipation of pain can increase muscle tension. Medica tions can help relax the client, enhance comfort, and improve motivation to increase activity (Gulanick, et al. , 1994). * Evaluation Short Term: Goal partially met. After 30-45 minutes of nursing intervention the patient was able to have a clear understanding with the use of identified techniques to enhance activity tolerance and was able to use all of the techniques except for the ambulation. He refused to walk because he complained of pain whenever the catheter tube slipped into his legs. Long Term: Goal partially met. After 2-3 days of nursing intervention the patient was able to continually participate in all of the identified techniques but still refused to participate in ambulation. He also reported of an improvement with regards to his activities as evidence by his verbalization, â€Å"Medyo natotolerate ko na rin yung mga activities kahit pautay-utay muna. Hindi ko lang talaga muna kaya maglakad pero pagnaalis na siguro yung catheter baka kayanin ko na. † XV. BIBLIOGRAPHY * Cosgrove DO, Meire HB, Lim A, Eckersley RJ. (2008). Grainger Allisonn’s Diagnostic Radiology: A Textbook of Medical Imaging (5th edition). New York, NY: Churchill Livingstone * Doenges M. , Moorhouse, M. ; Murr, A. (2006). Nursing Care Plans Guidelines for Individualizing Client Care across the Life Span (7th Edition). F. A. Davis Company, Philadelphia * Doenges, M. , Moorhouse, M. ; Murr, A. (2006). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th Edition). F. A. Davis Company, Philadelphia * Gabriely I, Leu, J. P. , Barky, N. (2008). Clinical problem-solving, back to basics. New England Journal of Medicine * Gould, B. ; Dyer, R. (2011). Pathophysiology for the Health Professions (4th Edition). Saunders Elsevier Inc. * Gulanick, M. Klopp, A. , Galanes, S. , Gradishar, D. ; Puzas, M. (1994). Nursing Care Plans Nursing Diagnosis and Intervention (3rd Edition). Mosby-Year Book, Inc. * LeMone P. ; Burke, K. (2007). Principles of Medical-Surgical Nursing: Critical Thinking in Client Care (4th Edition). Pearson International Edition * LeMone P. ; Burke, K. (2008). Principles of Medical-Surgical Nursing: Critical Thinking in Client Care (5th Edition). Pearson Internation al Edition * Mosby’s Pocket Dictionary of Medicine, Nursing ; Allied Heath (4th Edition) 2002, Mosby Inc. Palma G. ; Oseda A. (2009). G;A Notes Clinical Pocket Guide for Medical and Allied Health Professionals (2nd edition). G;A Notes Publishing Co. , Philippines * Sabol, V. K. ; Carlson, K. K. (2007). Diarrhea: Applying research to bedside practice. AACN Advanced Critical Care * Tortora G. ; Derrickson B. (2006). Principles of Anatomy and Physiology 11th edition. Biological Sciences Textbooks, Inc. * Weber J. ; Kelley J. (2007). Health Assessment in Nursing (3rd Edition). Lippincott Williams ; Wilkins How to cite Case Study – Appendicitis, Free Case study samples

New Management Style and Policies

Question: Discuss about the Report for New Management Style and Policies. Answer: Executive summary This paper seeks to analyze the importance of adopting a new management style and policies by Nike after finding itself in a reputational crisis after the sweatshop scandal. For a large corporation such as Nike any scandal will definitely affect the perception and trust that the consumers of its products have. We will use qualitative analysis in this paper and also analyse the various initiatives that Nike has come up with to restore stakeholders confidence and use qualitative analysis in our methodology. Introduction NIKE, Inc., is a design company based Oregon, Nike is among the leading companies involved in design, manufacture, distribution and marketing of shoes , equipment and apparel for sporting and physical activities all over the world. Nike has subsidiaries such as Cole Haan, which is involved in manufacturing and distribution of luxury items such as handbags, shoes and coats another subsidiary is Converse Inc., which also is involved in the design of accessories and distribution of athletic footwear, apparel and accessories(Aras Crowther, 2009). There is also a subsidiary called Hurley International LLC, which designs apparel and accessories for action sports and youth lifestyle and Umbro Ltd., which is a leading football brand company based in the UK. This paper focuses on the the management style and unethical issues that Nike has been involved in and why. Research methodology The paper covers ethical and unethical practices that Nike Inc. has been involved in. Data collection will be from past literature about Nike as well as the graphs and financial results of Nike in previous years. The research uses qualitative analysis of data concerning Nike Inc. the data will be obtained from journals, Nikes financial statements to analyze Nikes policies as well as the measures that they have put in place for improving CSR in the regions that Nike operates in. as a result, data collection will not take a long time since all Nikes information can be easily accessed in various mediums such as the internet Ethical and enethical practices by Nike In 1992, Nike had developed a code of conduct and a year before the report, had signed its adherence to the Global Compact which was launched by the UN Secretary General, Kofi Annan. Following this agreement Nike agreed to respect principles such as freedom of association and protection of human rights. By joining this initiative, Nike acquired a commitment to both consumers and with international organizations(Carbasho, 2010). So when reports were issued that Nike had engaged in unethical issues there was a serious reputational crisis. This was the labor practices in Bangladesh known as the Sweartshop scandal. This showed not only the social impact of a multinational company in the countries where it stands, but also the high cost that may involve not closely monitor all activity of Nike operated. Consumers reacted and Nike had to get going to keep the credibility of your brand. As a textile leader Bright business career in the industry began in the seventies when its founder, Phil Knight, director devised a revolutionary new model of sneakers that caused a sensation among athletes. Soon, the firm managed to gain a foothold in the textile sector reaching sufficient capacity to expand its product offerings. The market share of Nike has grown steadily to achieve the level it enjoys today. Today, Nike is at the top of the sports equipment industry with approximately 37% market share. It is also the most production jobs have moved outside North America. According Setem, a federation specializing in issues of cooperation and development NGOs, this American company makes 99% of its production in the Third World. For many companies such as Nike, Developing nations are attractive for factories due to the fact that they offer labor that is cheap in an environment that has free social legislation. Big companies preffer to work with local factories in order to develop a certain product, the main reason behind this is so that they can leave everything relating to emplo yees, , salaries, and working conditions in the hands of native producers(Simpson Taylor, 2013). The inadequate transparency that describe this production method has caused Nikeand other large multinationals, be closely watched by the critical eye human rights organizations that are integrated into the anti-globalization movement. Nike social responsibility Consequently, Niketried to address the problem by arranging various activities improve social work and dignity in the countries the factories were set up. Nike also decided to launch a communication campaign whose goal was to get people and moreso consumers end up associating and relating the brand to values of justice, dignity and equality. Nikeformulated a new code of conduct which outlined their business principles which endorsed its serious improvement purposes: (DeWinter-Schmitt, 2007). Moreso, the code would ensure continuity of its commitment to social values and also required that all its working partners adhere to thes e code., Nike is mainly committed to: 1. Respecting employees rights , this includes the right to free association and collective bargaining. 2. Ensure minimal negative impact on the environment in general. 3. Guaranteeing a safe and healthy workplace to the workers. 4. Prioritize on the health and welfare of all workers. Suppliers and transparency Nike also gave a very significant when publishing the list with the names and locations of its 700 suppliers and subcontractors plants worldwide step.This activity had never done before in the history of the textile sector and has come to be a milestone that unions and labor rights associations consider decisive. Nike said in a statement that any damage caused by competition following the publication of this list would not harm the potential benefits that the brand could acquire(Business as usual? The mobilization of the anti-sweatshop movement and the social construction of corporate identity, 2008). The report coincided with the publication of the second CSR report. role management function and how it is impacted by politics and the social environment; Effective management aims at ensuring that the company achieves its set objectives. Management function is affected by politics and social environment, for example in the case of Nike, the company was forced to adopt a new style in which it would manufacture its products while ensuring that they adhere to safeguarding the workers interests including provision of a good working environment. The politics of how multinationals violate human rights in developing countries played a key role in ensuring that the management observes this aspect without negatively impacting on the bottom line(Ferrell, Fraedrich, Ferrell, 2010). Politics are behind the managements decision to change on the ways they were doing production. Also, Nikes management has promoted its plan of using soccer as a movement to enhance social change. This is inline with the managements focus on the social environment . For example, An example of a program the company partners with is Grassroots football . This is a community program that directly addresses an extreme social need through awareness especially in deveoping countries. The report notes that during the supplier audits supervised by inspectors of the FLA, four areas of breach of code of conduct were detected: freedom of association, wages, working hours and harassment in their factories. However, improvements were seen in the areas of child and environmental work(Simpson Taylor, 2013). Looking ahead, Nike confirmed in the document their commitment to advance in three different direction.It is increasingly common to find a responsible CSR within the structure of Nike or see codes of conduct drafted and enforceable also extensible to suppliers(Morsing Beckmann, 2006). Companies are becoming interested in training their employees on human rights as well as working on improving their systems testing and evaluation work in subcontracting factories. It is clear that these large multinational companies remain leaders in their respective areas despite having chosen a committed CSR policy.Already it is seen that the fact of adopting labor principles in line with the new social demands is not at odds with the pursuit of profit.Turning pointIn October 2000 a reporter for the BBC, Paul Kenyon, traveled to Cambodia to investigate working conditions in factories. Subsequently, a report with the Nike Gap No sweat name issued in which the harsh working conditions in subcontracted factories are kept awake by these companies(Morsing Beckmann, 2006). Children under fifteen years working in endless shifts and sexual abuse by officials of the factory were some of the practices that the BBC brought to light. The impact of the scandal made both Nikeand Gap closed down factories in Cambodia. As a result, the country lost 10 million dollars in contracts and hundreds of natives were fired from their job. Nikes Management Most of the texts have served as a basis for designing this course, they use different terms: policy, strategy and tactics. In general the term "politics" and its different meanings, set standards for the management of Nike and its behavior in the market, and sometimes cover a period of ten years(Ferrell, Fraedrich, Ferrell, 2010). Covering the objectives of Nike as well as methods for their behavior. Nike is a strong company when it comes to sustainable and innovative business (Sustainable Business and Innovation, ). This approach was integrated consistently with Nikes business strategies of , this was aimed at generating greater income for Nike and a more sustainable business model to cater for the communities, consumers, factory workers e.t.c. Politics and social environment determine how the management formulates their policies; this is because the policies should not go outside the policies of the government(Visser, 2011). The management style ensures that Sustainability and innovation is key to innovation and growth of the products as well as revenues of Nikeaccording to Mark Parker, CEO of NIKE, Inc. politics and social environment made Nike change how they were going to operate going forward in terms of Making the business sustainable and beneficial to customers, and have a low impact on environment, the factories workers will enjoy a good environment in production and employees growth and shareholders value who will be rewarded from the management style. The management report announces progress Nikeregarding the five-year objectives that were established in 2007. Nike has made considerable progress in many aspects, for example the execution of training in efficient management which is also known as (Lean Management) in factories that have been contracted, use of environmentally preferred products and reduction of waste and toxics and increasing in all high performance considered Design of materials.The management has also moved towards removing th e most challenging aspects of progress regarding the purpose of Nike, for example, the how to deal with overtime in contract involving the workers. Nike and management has the objectives in some to reduce the complexities which is a change in strategy in how to manage Nike(Micheletti, Fllesdal, Stolle, 2004). Efficient Management (Lean Management) and human resource management. One of the management strategies is to train factory workers with an aim of creating and implementing efficient manufacturing in Nike hence there is need to have a good human resource management programme.. efficient management decision-making principles are critical as they bring the worker closer through skills, understanding quality and teamwork understanding. References Aras, G. Crowther, D. (2009). Global perspectives on corporate governance and CSR. Farnham: Gower. Business as usual? The mobilization of the anti-sweatshop movement and the social construction of corporate identity. (2008). Carbasho, T. (2010). Nike. Santa Barbara, Calif.: Greenwood. CSR handbook. (2001). [Washington, D.C.]. DeWinter-Schmitt, R. (2007). Business as usual?. Ferrell, O., Fraedrich, J., Ferrell, L. (2010). Business ethics. Mason, OH: South-Western Cengage Learning. Green, S. Nike. Micheletti, M., Fllesdal, A., Stolle, D. (2004). Politics, products, and markets. 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