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Opportunity to live Essay During the old occasions before detainment, there were executions and executions just which were fairly finished by stoning. There were comprised of a few reasons concerning why the death penalty was required. The United States acquired its utilization of the death penalty from the European pioneers in the seventeenth century yet in the eighteenth century, German scholar Immanuel Kant offered that execution was the â€Å"fairest discipline for murder†. He introduced that it is the most appropriate discipline for the individuals who have submitted murder and that an individual who has fouled up ought to languish over it. Contending that executioners ought to â€Å"die so as to pick up discharge from their suffering†, including that the wrongdoing must fit the discipline. Contentions against capital punishment uncover the death penalty for what some accept is a sensible discipline, while others see it as vengeance camouflaged as equity however generally speaking, is ceaselessly an issue that would not be similarly examined and nullified around the world. Differences about capital punishment generally turn on issues of decency, ethical quality and adequacy. There comprises of unlimited reasons with respect to why capital punishment is to be abrogated. One of many is that executions cost more than life in jail. As indicated by Statistic Brain, it costs almost 2 million for every individual to be executed, all which comprises of greatest security, counsel for protection and others. Another well known point is that the blameless might be wrongly executed. This is a high hazard since proof, DNA, and witness proclamations are not 100% dependable. A marginally pertinent case was a dishonestly executed man named Cameron Todd Willingham. He was executed in Texas, known to be the main state with the most elevated pace of executions. He was blamed for supposedly setting his home ablaze that slaughtered his three youthful girls. He more than once asserted his honesty and the fire related crime agent was addressed just before Willingham’sà ¢â‚¬â„¢ execution. After his execution, an analytical report found the fire was a mishap. A few reasons incorporate that capital punishment discipline does notâ necessarily diminish the crime percentage, that life in jail likewise ensures no future wrongdoings, a few religions preclude capital punishment, murdering isn't right even through a discipline, that it abuses universal human rights laws and that it advances executing as a good answer for a troublesome issue. A typical factor with regards to why individuals contradict capital punishment is a direct result of the savagery of the demonstration itself, for example, the regular contemporary techniques for execution, for example, by shooting, hanging, utilizing gas, electric shock and deadly infusion. Concurring Amnesty International who are solid non-supporters of capital punishment, the death penalty is the definitive dismissal of human rights. It is the â€Å"premeditated and wanton slaughtering of an individual by the state†. A large portion of the measures of US States have prohibited capital punishment for instance New York, thinking that its unlawful. In Just Revenge by Mark Costanzo, he expresses that most Americans are steady of capital punishment in the theoretical by essentially needing the administration to deal with it, â€Å"cleanly and proficiently, in an inaccessible prison†. He addresses that â€Å"is it ethically adequate to expose killers to mental torment before we slaughter them?†. While others guarantee it is an unforgiving, brutal and undignified discipline done â€Å"in the name of justice†, remembering that dispensing discipline for transgressors debilitates others from wrong doing. Some may state that capital punishment is an a pproach to lash back at the individuals who have hurt us, however helpfully we should be more sensible and altruistic than the individuals who submit the demonstration themselves. The individuals who favor capital punishment contend that if there were no capital punishment to hold over the head of detainees, the individuals who have been condemned to existence without the chance for further appeal would be allowed to perpetrate whatever violations they picked unafraid of expanded discipline. Capital punishment supporters regularly press two cases of executing killers. The first is that it is bad form to the survivors of homicide on the off chance that we don't execute their killings. The subsequent case is that capital punishment is expected to terrify possible killers. Dread of the execution chamber will control expected homicides, realizing they could confront the killer and that the individuals who in any case slaughter will stop and honest lives would be spared. Another factor regarding why capital punishment is legitimized is it offering conclusion to victims’ families who have experienced hugely the loss of their adored one. And furthermore a detainee can get away from jail and allow them to murder. Capital punishment is supposed to be expected to shield society from the individuals who might slaughter once more. A large number of these variables which relate back to vindicate. Sometimes, the death penalty is a â€Å"risk taker†. There are sure cases in which murdering a criminal can prompt addressing regarding whether the individual was blameworthy of the wrongdoing. Capital punishment neglects to successfully develop a general public that is liberated from wrongdoing. Besides, it doesn't assuage the torment and loss of the people in question or their families. States have made numerous proposition regarding why the death penalty isn't right. As residents, capital punishment doesn't mitigate the dread of fierce wrongdoing or better safe-watch the individuals and isn't forced with reasonableness. Pope John Paul II made an understood point in an announcement he made about capital punishment. He expressed â€Å"the capital punishment doesn't permit the open door for the profound and human compromise with the victim† and furthermore that â€Å"we can't encourage that executing isn't right by killing†. This statement is an awesome guide to supporting nullifying capital punishment that we can't instruct that killing an individual isn't right by slaughtering a crook. Contingent upon the nation, there are various perspectives regarding whether capital punishment ought to be annulled or not. The variables on the two sides of the contention have prompted the cancelation of capital punishment in Eastern Europe. For instance, Ukraine has put an interruption to its discipline of capital punishment, just as South Africa, whose parliament casted a ballot to officially cancel capital punishment, which had prior been pronounced illegal by the protected court. Their protected court accepts that demise is the most extraordinary type of discipline. They accept each individual has the option to life, nobility, general sentiment. In addition to the fact that this is an issue in the United States, yet very well far and wide. In India, the Indian Penal Code approves the burden of capital punishment as a punishment of homicide. In spite of the fact that it is almost unimaginable for the abolishment of capital punishment to be adjusted and comprehended by the two sides of the contentions, the thoughts and assessments will never blur. With a few states not having capital punishment, the genuine inquiry is whether we need capital punishment. The death penalty isn't the center of our criminal framework; its just a single part of it. Just a little level of killers are condemned to death, and just a little level of that are executed. The genuine inquiry is whether we demand keeping capital punishment despite the fact that we don’t need it. WORK CITED End Capital Punishment. Nullify the Death Penalty. Pardon International USA, 2013. Web. 23 Apr. 2013. Costanzo, Mark. Simply Revenge: Costs and Consequences of the Death Penalty. New York: St. Martins, 1997. Print. Authority of Justice Statistics. Capital punishment Statistics. Measurement Brain RSS. Measurement Brain Research Institute, 6 Aug. 2012. Web. 23 Apr. 2013. Kronenwetter, Michael. The death penalty: A Reference Handbook. Santa Clause Barbara, CA: ABC-CLIO, 2001. Print.

Strategies of Maintaining Work-Life Balance

Question: Clarify the methodologies of keeping up Work-Life Balance. Answer: Presentation The work-life balance is a thought that includes an exact organizing between the way of life and work of an individual (Wilton, 2013). The work incorporates the desire and profession and then again, the way of life incorporates joy, wellbeing, recreation, profound turn of events, family and reflection. A sound work-life parity can be accomplished by dealing with the individual and expert existence of a person in practical manners, which help to keep the vitality streaming in an individual, and keeps the bodies and brains on the individual solid and entire selves content and glad. Techniques of Maintaining Work-Life Balance These days work-life balance is considered as the most significant characteristics of the work environment, also, it is considered as remuneration and it has been discovered that the laborers who think and feel that they have a superior parity of work-life, for the most part work 21% harder than different representatives who feel that they exhausted. This infers to give regard for all the things that are satisfied and improved including profession, work, wellness and wellbeing are similarly significant for adjusting the work-life of a person. The techniques that can be suggested so as to keep up a superior work-life balance include: Following the time By breaking down the current circumstance one can accomplish a healthy lifestyle. One should keep a period log of the considerable number of things he accomplish for seven days that is both the individual and business related exercises. Every one of these information go about as an eye-opener as these data help in understanding the utilization of time for the correct work to be done and in this manner helps in sparing time (Werner, Schuler, Jackson, 2012). Deciding the needs of an individual An individual ought to invest some energy for posting the needs and afterward as needs be one should work at home and at work place. Defining up Specific Goals according to the rundown of needs, one should take into a lot of concrete and quantifiable targets. This causes a person to set objectives and furthermore assists with adjusting time between the work and the individual exercises. Booking Carefully The effective arrangement by and large make arrangement for their work. This is named as date organizer. On the off chance that an individual spotlight on his date organizer and in like manner play out his occupations, at that point inside a moderately lesser time he can perform more (Mondy, 2012). An individual can cautiously consider the date organizer toward the start of the day and as indicated by his arrangement he can perform. Setting up Boundaries An individual should set a practical and reasonable cutoff to both the exercises at work and at home. These limits ought to be spoken with the collaborators, directors, family and accomplice (Ivancevich Konopaske, 2013). This helps a person in overseeing time. Dealing with the Health For each person, wellbeing is in the highest need. In this manner, every individual ought to be in a decent shape both inwardly, intellectually and genuinely as these variables put an emphasis on both the work life and individual life. Sustaining Relationships and Family The family and the companions are those connections that give fulfillment to the individuals. Hence, every individual ought to invest energy with their relatives and companions so as to dispose of the pressure of the work (Dessler, 2013). These connections give fulfillment to the people. Hence, it very well may be said that supporting connections and family help to keep up a decent work life equalization and this additionally causes a person to perform better in his work place. Setting aside a few minutes for Own self An individual ought to give and hush up about time. This gives a person to perform better in the working environment. Going home at Workplace By finishing errand or work of a person at the work environment encourages the individual to give time to his loved ones (DeCenzo, Robbins, Verhulst, 2013). This additionally assists with keeping balance between the work life and the individual life. Working insightfully and not barely - One should work in an arranged manner. This causes a person to work more without giving all the more difficult work. Knowing the Right Time for Asking Help When the individuals are overpowered with work and stress, at that point one should take help from others. This assists with decreasing pressure and in this way an individual can adjust well between the work life and individual exercises (Bohlander Snell, 2013). End In this manner, it tends to be presumed that by executing all the twelve systems appropriately, an individual can keep up a superior adjusted work-life. It can likewise be said that there are essentially three purposes behind which the work life balance is significant. These incorporate the people become less helpless to the burnouts, appropriate consideration can be given where it is required and the people likewise experience less medical issues. Along these lines, it very well may be said that so as to lead the work life balance in a superior manner, each individual ought to follow the above expressed techniques. References Bohlander, G. Snell, S. (2013).Principles of human asset the executives. Australia: South-Western/Cengage Learning. DeCenzo, D., Robbins, S., Verhulst, S. (2013).Fundamentals of human asset the board. Hoboken, NJ: John Wiley Sons. Dessler, G. (2013).Human asset the board. Boston: Prentice Hall. Ivancevich, J. Konopaske, R. (2013).Human asset the board. New York, NY: McGraw-Hill Irwin. Mondy, R. Mondy, J. (2012).Human asset the executives. Boston: Prentice Hall. Werner, S., Schuler, R., Jackson, S. (2012).Human asset the board. Australia: South-Western Cengage Learning. Wilton, N. (2013).An prologue to human asset the executives. London: SAGE.

The UAP Hallmark Programs Free Essays

Last September 22, 2000 was the People Development Day of the University of Asia and the Pacific (UAP). It was featured with a program that turned into a social affair of the high positioning characters the college has like the UAP president, Dr. Mario D. We will compose a custom paper test on The UAP Hallmark Programs or on the other hand any comparative point just for you Request Now Camacho; the Dean of the College of Arts and Sciences, Dr. Antonio Torralba; the Vice President for Administrative Affairs, Dr. Josemaria Mariano; and the program executive of the People Development, Mr. Jun Papelleras. Dr. Antonio Torralba talked about the UAP trademark programs which I am going to handle all through this paper. The word trademark implies a distinctive trademark sign, quality, or highlight that makes one of a kind. On account of the UAP, it has three trademark programs which are specifically: values instruction; individuals improvement; and research and correspondence. In the field of qualities training, the UAP is resolved to show its understudies with the privilege and appropriate qualities and mentalities that will help for the advancement of the general public as well as for their basic great. Indeed, the college offers courses in social and expert arrangement of virtues. With this, the UAP expects to create understudies with discipline, ingenuity, soul of big business, trustworthiness, social solidarity, and widespread standpoint. The subsequent trademark program of the UAP is the individuals advancement. In this field, the college understudies are prepared to be: ecologically mindful in our environmental factors; helpful to other people; values situated; worry to their wellbeing and to the best possible food nourishment; puts something aside for activation; and appropriately instructed people. The UAP accepts that through these six projects of individuals advancement, the understudies will accomplish its fullest potential as a prosperity. The last trademark program of the UAP is the examination and correspondence which is the central points of its trailblazer, the Center for Research and Communication. It is said that the UAP proceeds with its inquires about with the humanistic, proficient, logical and specialized information for the benefit of everyone of the general public. The college, through research and correspondence, means to be an apparatus for the upliftment of the good and economic wellbeing of society. Really, the UAP has any kind of effect through its three significant trademark programs as contrast with different colleges and organization in the land. Furthermore, that makes the UAP remarkable and stand-out. Instructions to refer to The UAP Hallmark Programs, Papers The UAP Hallmark Programs Free Essays Last September 22, 2000 was the People Development Day of the University of Asia and the Pacific (UAP). It was featured with a program that turned into a social event of the high positioning characters the college has like the UAP president, Dr. Mario D. We will compose a custom exposition test on The UAP Hallmark Programs or then again any comparative subject just for you Request Now Camacho; the Dean of the College of Arts and Sciences, Dr. Antonio Torralba; the Vice President for Administrative Affairs, Dr. Josemaria Mariano; and the program executive of the People Development, Mr. Jun Papelleras. Dr. Antonio Torralba talked about the UAP trademark programs which I am going to handle all through this paper. The word trademark implies a distinctive trademark sign, characteristic, or highlight that makes one extraordinary. On account of the UAP, it has three trademark programs which are to be specific: values training; individuals advancement; and research and correspondence. In the field of qualities instruction, the UAP is resolved to show its understudies with the privilege and appropriate qualities and mentalities that will help for the improvement of the general public as well as for their normal great. In actuality, the college offers courses in social and expert arrangement of virtues. With this, the UAP plans to create understudies with discipline, constancy, soul of big business, trustworthiness, social solidarity, and general viewpoint. The subsequent trademark program of the UAP is the individuals advancement. In this field, the college understudies are prepared to be: earth mindful in our environmental factors; agreeable to other people; values situated; worry to their wellbeing and to the best possible food sustenance; puts something aside for assembly; and appropriately taught people. The UAP accepts that through these six projects of individuals improvement, the understudies will accomplish its fullest potential as a prosperity. The last trademark program of the UAP is the exploration and correspondence which is the essential points of its herald, the Center for Research and Communication. It is said that the UAP proceeds with its looks into with the humanistic, proficient, logical and specialized information for the benefit of all of the general public. The college, through research and correspondence, expects to be an apparatus for the upliftment of the good and economic wellbeing of society. Really, the UAP has any kind of effect through its three significant trademark programs as contrast with different colleges and organization in the land. Also, that makes the UAP one of a kind and exceptional. Step by step instructions to refer to The UAP Hallmark Programs, Papers

Principles of Advertising Study Guide

* Advertising Business †Either utilizing an office or have your own publicizing division/promote all alone. Government †is an administrative body, make laws to control publicizing, things you can promote and things you cannot promote Cigarete Comercials on TV Lobby †Corp attempting to campaign gov. to change for the great, two powers, that think gov, is a positive thing and thinks its bravo to control everything and maintain things in control. other people who think the gov. should be littler, and that they ought not have as much control. Society †the way of life that your raised in, custom, ethics and estimations of the people.Business Finance †the measure of cash associated with publicizing to advance your item. Advertising †Finding a need that the individuals need, and filling that need. Promoting †Non individual (to everybody whose viewing, not simply to one individual), Always paid for, correspondence of information about the organizations item , administration or thought through the different medias (Television, Radio, Magazines, Internet) Public Relations †making sense of what the individuals need. Exposure †precisely like publicizing yet free Personal Selling †what you selling is moderately costly, and elite. Public exhibitions †where organizations get the opportunity to meet viewpoint corp. uyers, they can purchase a great deal of stuff for the benefit of their organization. Advancements †any incitement or fervor to get you amped up for the organizations item. (giving out free shirts) Operations †whatever the organization does Types of business sectors publicizing follows Consumer Market †things you may see on television or hear on the radio Business/Profesional Market Government †Trying to offer things to the administration, and Profesional †promoting for bookkeeping programming, and things that your by and large not going to peruse for delight, however there going to be ap proaches to improve your business.Bar Magazines, nobody is going to purchase the stuff in that magazine, yet proprietors of restraunts are going to get it. Business †attempting to get your lager on the principal rack, and managing the supermarket , or alcohol store Integrated Marketing framework †Customers get notification from a different measure of various markets. (Flagler College business Cards) The consistency so everybody recognizes what an organizations about, and what their picture, logo, and motto is.All state †Have their lil trademark on anything they hand out, â€Å"The Good Hands People†, and have their logo on most things, and have their shading that they generally use, so it will toward the end in people groups recollections and they partner everything their organization with it. Craftsmanship to making legitimate publicizing to get their message out appropriately. Theres going to be a persona (Spokesperson), a Medium (Getting the message out with an appealing expression or something) , and the manner in which individuals will get it. Representative †Someone that talks in the interest of an organization. hello can be an individual (like William Shatner for priceline) however they can likewise be a persona (like Ronald Mc’Donald), essentially any individual that’s getting the organizations message out. They ought to be appealing, and will utilize snappy expressions (metro foot-long melody, or I need my Baby Back Ribs) You need that imaginative eye, certain shading combos can have a significant effect and mean totally various things. A ton of times they will publicize things as being greater, and sounding better than they are. A ton of organizations will take out a portion of the item, Bags of potato chips, making a brew just 11. 5 ounces as opposed to 12. out of 5 dental specialist suggest it ( that’s not a ton of dental specialist out of the millions that exist) Price Economic Argument †Argumen t that opposition Exclusive Distributions †you have to purchase the option to sell a specific item here. Promoting propagating generalizations †publicizing can once in a while bring out generalizations for specific individuals. They have ladies in the kitchen in advertisements, and men continually accomplishing the work. Advertisement offices need to direct themselves, they really meet each year to make sense of what they can do, and what they can’t do. FTC †Federal exchange commission manage any organization that trades with more than one state.If there isn't exchanging included more than one state than it is commonly simply directed by the states capital The FTC will advise individuals to not air something, and ensure that nothing hostile is broadcasting in real time. On the off chance that you don’t sign the agree to concur, at that point you have commit another business revising your error, and putting out another promotion with the remedy on your co st. (remedial publicizing) Puffery †is embellishment, and that is something you can do. * self realization †turning into the top , chief, of an organization, you’ve demonstrated to the world that your at the top, and are exceptionally effective. For the most part these individuals will purchase the costly vehicles, vessels, planes, watches, and ect. * Assumption Factor †Never expect you comprehend what your objective is, or what they need. * Task Utility †item or administration that accomplishes something for you, makes carrying out a responsibility simpler. * Premade food * Form utility †when a producer assembles many pieces that you would not have any desire to do. * A PC being worked for you, a seat, ect. * Time Utility †item or administration accessible when you need it. * Can’t purchase a Harley Davidson immediately, going to be at any rate a couple of months to get one. * Where utility †the item is accessible where you want.This incorporates being conveyed to your home. * â€Å"Perception is the reality† †on the off chance that you see an item to be better, than it is. * Ch. 1 Advertising Today Advertising lets client mindful of an item, appreciate what its utilized for, and perceive how it is not the same as its opposition. Data will help make a conviction, that this item is better. It will at that point give the client a longing to purchase from this retailer, and assist them with making the move to purchase an item. Coordinated Marketing Communications (IMC) †when purchasers get predictable and positive messages about a brand.Marketing Communications †Tools that organizations and associations use to initate and keep in touch with their client, customers, and possibilities. Promoting †is the organized and made nonpersonal correspondence out of data, generally paid for and normally powerful in nature, about items by distinguished backers through different media. A sort of corres pondence, organized, and made Directed to bunches out of individuals, not people so its nonpersonal Most is paid for by supports Public assistance messages †conveyed at no charge in view of their not-for-profit status. Item †includes merchandise, administrations, and ideas.Medium †the channel of correspondence promoting contacts us through. Informal (WOM) †when you tell someone the amount you like an item. Turning out to be increasingly mainstream because of twitter and facebook. Broad communications †the conventional method of publicizing. Addressable media †regular postal mail. Intuitive media †the web Nontradional media †shopping baskets, zeppelins, and dvds. * Two kinds of measurements in promoting * Communication measurement †how publicizing is really a type of organized, artistic correspondence. Showcasing measurement †clarifies the significant job promoting plays in business.Economic measurement †shows how and why publici zing advanced as it did. Social and moral measurement †thinks about the effect of promoting on purchasers, organizations and society. * Source Dimension Sponsor †the organization promoting an item or thought, legitimately answerable for the correspondence and has a message to convey to genuine customers. Creator †the supporters promotion organization, an innovative group at an advertisement office. Persona †genuine or fanciful representative who loans some voice or tone to the promotion. * Message measurement Autobiographical †recount to a tale about myself to you the nonexistent audience.Narrative messages †a third-individual persona recounts to an anecdote about others to an envisioned crowd. Dramatization message †the characters carry on occasions straightforwardly in front on an envisioned epmpathetic crowd. * Reciever Dimensions Implied purchasers †Adressed by the ad’s persona, envisioned by the ad’s makers to be the perfect customers who acknowledge uncritically the contentions made by the promotion. Sponsorial customer the watchmen who choose if the promotion will run or not, gathering of leaders at the patrons association. Genuine Consumer †individuals in reality who make up the ad’s target audience.They will really get the chance to see and hear the promotion . * Feedback †finishes the cycle, confirming that the message was gotten. * Every business has three expansive useful division †Operations, Finance, and Marketing. * Marketing †the way toward arranging and executing the origination, evaluating, conveyance, and advancement of thoughts, products, and administrations to make trades that atisfy the apparent needs, needs, and targets of people and associations. Shopper publicizing †most promoting falls under this classification. Retail publicizing †promoting supported by retail locations and organizations. PSA (Public Service Announcements) â€Industrial/Busin ess Markets Business to business †infrequently observed by the really purchaser, since they will by and large represent considerable authority in one office. Kitchen Magazines for restraunts. Exchange Advertising †Wholesalers, retailers, and vendors. By and large an item is offered to these organizations so they can dispose of a mass quanity at once. Proficient publicizing †promoting focused on educators, bookkeepers, specialists, engineers, ect. Used to persuade experts to suggest or endorse a particular item or administration, to purchase brands of gear and su

Ethics in Animal Research Free Essays

As far as morals, the principle issue in creature testing is just that numerous exploratory creatures endure in manners which are unnatural to them. Using hereditary control, large mice , diabetic mice, and mice with Huntington’s illness can be made. Careful tests can be performed on bigger creatures â€, for example, pigs, sheep, and mutts, as â€Å"practice† for human medical procedure. We will compose a custom exposition test on Morals in Animal Research or then again any comparable subject just for you Request Now Regularly, such things would not occur to these creatures. Any enduring they may understanding during such examinations is completely the creation of the scientist †and regularly these creatures are reason reproduced and would not by any means exist on the off chance that it were not for the exploration. These creatures have been reproduced by us, for our utilization, and endure on our benefit. As humansâ€the predominant species on the planetâ€we can treat creatures in any capacity we pick, and do with them what we please. The inquiry is, is it moral, or moral, to treat them in manners which cause enduring †regardless of whether it is to our advantage? To certain adversaries of creature experimentation there are no advantages which legitimize the utilization of creatures; others accept that creature experimentation is adequate giving that enduring to the creatures is limited. Still others contradict creature testing specifically based on the motivation behind the tests, accepting that creature experimentation for the progression of clinical science is adequate, yet corrective testing isn't, for instance. Are Animal Tests Reliable? Rivals of creature experimentation point to the conspicuous contrasts among people and different creatures as evidence that creature examine isn't solid. In any case, while it’s genuine that people react distinctively to specific substances than do other creature species (arsenic isn't harmful to sheep, for instance, and chocolate is poisonous to hounds), there are a lot a larger number of likenesses than there are contrasts †and toxicology contrasts don’t invalidate the legitimacy of hereditary investigations, for instance. Another problem that is begging to be addressed is one which was first voiced in 1655 by Edmund O’Meara, a physiologist, who stated, â€Å"the hopeless torment of vivisection puts the body in an unnatural state. In the event that a trial creature is in agony, or endures in any capacity, during an investigation, may that not raise doubt about the precision of any outcomes picked up in the exploration? What's more, if so, doesn’t this further inquiry the morals of creature look into? All things considered, utilizing creatures along these lines is significantly increasingly despicable if the precision of the outcomes is in any uncertainty whatsoever. The capacity to accomplish dependable, reproducible outcomes is a foundation of the logical strategy, and it is vital that creature testing is capable accomplish those outcomes A Matter of Practicality Most of the most significant advances in clinical history in the twentieth century were made utilizing creatures as guineas pigs. It is suspicious whether a large number of these would have been accomplished if creatures were not accessible for use by clinical specialists. There are options in contrast to creature look into (these will be analyzed in the following article in this arrangement), however by and large they are essentially not satisfactory substitutes for an absolutely real living being. The Institute for Laboratory Animal Research of the U. S. National Academy of Sciences concurs that even the most modern PC displaying is right now unfit to effectively demonstrate the atomic and cell connections that happen in even minimal complex of live life forms, especially in a natural setting. Clinical science is in understanding, generally, that the utilization of creatures in clinical research is a pragmatic need. Both the United States and the British governments , among numerous others, bolster the utilization of creatures in inquire about, gave that enduring of test creatures is limited. Step by step instructions to refer to Ethics in Animal Research, Essay models

Counting On One Hand

Counting On One Hand the number of semesters completed at MIT. So today, I waved farewell to my fifth semester at MIT. Its kinda creepy how time seems to be going by so fast. Now I must say that Ive made the following observations about life here: Hard work pays off. It really does. Things dont just fall out of the sky and WEBSIS doesnt let you pick your own grades, you have to work for them. This observation was prompted by the fact that sometimes this semester I wanted to throw my hands up and give up, but in my experience here, we students dont like that attitude. One way or another you drink from that firehose and you get it done. I can say that this semester was the first semester for many things for me. Yesterday, I had the hardest final exam of my life. The concepts in the class are very theoretical and abstract, and the test simply just wasnt. Needless to say, Ive never walked out of an exam questioning the validity of the response I put down to every question,but the professor apparently agreed with my logic =). This was the first semester that I came close to pulling an all-nighter. Before coming to MIT, I told myself that I wouldnt pull an all-nighter. I dont really remember why I made this deal, but Im sticking to it, or at least trying to. Also the first semester Ive been able to wake up on time without my alarm clock. So with the end to this semester, it means Im on my way home to spend the holidays with family and friends. Itll be nice to return to flip flops and a tshirt as I bask in the warm weather home to Ryan, Marissa, Seth, and Julie Cooper Nichols. Ben, do you get the reference? Until then, for those of you finishing off your applications to MIT, best of luck to you! For everyone else, Happy Holidays, and Ill see you when I wake up from my three-day-long nap.

Should I use the Common App or the Coalition App

Should I use the Common App or the Coalition App? Rising seniors who will be applying to competitive colleges this fall are almost sure to soon face the question, â€Å"Which is better, the Common App or the Coalition App?†This budding rivalry isn’t quite yet on par with Coke vs. Pepsi, Ford vs. Chevy, or Nike vs. Reebok. Rather, the case of the Common App vs. the Coalition App better resembles one of those start-up business tales that we all love, where a feisty newcomer tries to dethrone the industry goliath. You know—the storyline where a bunch a geniuses toil away in a garage, pursuing an innovation that will bring some mighty corporate giant to its knees. Except in this version, the feisty upstart (the Coalition App) happens to have the backing of just about every college and university in the country that boasts a combined endowment of countless billions of dollars.The brewing battle between the Common App and the Coalition App is evidenced by the sheer volume of questions that out staff at College Transit ions have been fielding on the subject as of late. In the interest of providing some clarity, let’s start by taking a quick look at what each application is all about and then we’ll delve into the differences through a Q A, addressing the most frequent questions that we receive from clients on the subject.The Common App in a nutshellIn 1975, a small grouping of private colleges, possessing both overlapping admissions requirements  and  applicant pools, forged an agreement to develop a common application form that could be Xeroxed and submitted to all schools within the cohort. By the mid-1990s, the movement began to spread to more and more institutions and soon the Common Application migrated online, started to include public schools, and switched from being volunteer-run to an incorporated non-profit. Growth has continued throughout the 21st  century, as the number of participating schools has more than doubled in the past decade leading to its present number o f member schools—740 institutions. Out of these, roughly one-third will only accept the Common App.The original intention of the Common App remains its intention still today. It is a tool that helps to streamline the process of applying to multiple schools, allowing students to enter their demographics, educational history, test score data, activities, and essay just one time, saving applicants valuable time and headaches.The Coalition App in a nutshellCurrent high schoolers who, in the preliminary phases of their college search process, encounter The Coalition for Access, Affordability, and Success are often a tad confused by the clunky name that sounds like either A) the world’s lamest team of superheroes, or B) a defunct Soviet ministry. In actuality, â€Å"The Coalition† is a collection of colleges and universities that all meet a series of criteria demonstrating that they graduate a high percentage of their students within six years and have a strong track record of meeting applicants’ financial needs.In order to promote increased access, the Coalition App is designed to engage students in the college process earlier in their high school careers. It also aims to make the application more holistic and organic than the Common App. Students are given a digital â€Å"locker† in which they can enclose writing samples, multimedia artifacts that represent their unique passions or talents, and are encouraged to connect with mentors of all varieties (counselors, community members, admissions counselors) to seek out advice as early as in 9th  grade.The Coalition’s numbers rise each month, and the total number of schools  is now over 150—last year there were only 112 members.Does one give an admissions advantage?There is no admissions edge either way. Coalition schools have already stated that no one will be punished for using the Common App.Is there a price difference?Nope—both are â€Å"free† platf orms—but of course you still have to pay the individual fees to each college or university to which you apply.Do any schools require the Coalition App?Yes, but it’s a short list. In the 2018-19 admissions cycle, only the University of Maryland, University of Florida, and University of Washington will require students to apply through the Coalition App. At this time, it is optional at all other schools within The Coalition.Are the essay prompts different?Yes. However, there will no changes to either platform’s essays for the 2018-19 admissions round. You can check out The Coalition Essay Prompts by  clicking  here, although it is important to note that not every Coalition school requires an essay. At some colleges, writing samples included in your digital locker can be substituted (the whole â€Å"more organic† thing). The Common App essays have undergone some changes from previous years which we recommend reviewing in our  previous post  on the su bject.One additional difference are the length requirements. The Common App software will not allow you to enter anything over the 650 word limit. The Coalition App limits applicants to 2500 characters which should work out to roughly 500 words.How do most applicants apply to Coalition schools?The 2016-17 admissions cycle was the debut of the Coalition App and it failed to make a major splash. At Yale, a paltry 1% of the applicant pool, just 317 total students, selected the Coalition App over the more traditional Common App. At Emory University, fewer than 1,000 of the 23,694 total applications were submitted via the Coalition Application. Data from the 2017-18 cycle is sparse, but it does not appear the number of users rose dramatically, even with such low baseline levels.Which is more convenient?We personally find the interface of the Common App easier to use at this time. Having been online for almost two decades, they’ve successfully worked out many of the kinks and conti nue to make  improvements  each year. The Coalition App, on the other hand is new, and, as is to be expected, had its fair share of technical difficulties in year one.Who does the Coalition App make sense for?If your list is comprised exclusively of schools that accept the Coalition App and you feel that its unique offerings (i.e. the storage locker, writing sample, etc.) work to your benefit, then by all means—give the Coalition App a try. This scenario would only be likely for a high-caliber student applying to many elite colleges, since that is who makes up the majority of The Coalition.On the other hand, if you plan on applying to ten schools and only two or three are Coalition members, then filling out both applications isn’t likely going to be a great use of your precious time.College Transitions’ Bottom Line:For rising seniors who are gearing up for the 2018-19 admissions cycle, we do not, barring unique circumstances, recommend using the Coalition Ap p at this time. We do advise that students currently entering 9th  or 10th  grade who have their eyes on elite colleges at least begin archiving the best examples of their academic work as additional Coalition schools may mandate use of their application in the coming years.

Writing Strategies Developing Believable Characters And...

The two main writing strategies my placement has focused on thus far, are developing believable characters and writing drafts. To develop characters, we have taught the students to use the skills they learn in their reading lessons, and transform them onto the pages of their notebook. As mentioned, we have been working on identifying, and empathizing, with characters in reading. These same skills are needed for both reading about and writing about characters. The class is currently working on creating realistic fiction stories centered on a protagonist. The main focus of this unit is ensuring the characters created are believable, meaning do they seems like a person who could exist in real life. To accomplish this, students must make inferences about the different aspects of their character. All of the different aspects and traits of these characters need make sense in concert with one and other. The other main strategy they have learned in writing is how to write a draft. I model fo r the class how when writers create a first draft, they write in stream of consciousness. Meaning that the writing is less about correctness, and more about getting ideas on the paper. From there we discussed how writers edit these drafts, and ultimately revise the content into a publishable story. Through these examples, it is clear that this component of Tompkins balanced approach is being met. The fourth and fifth aspects of this approach are vocabulary and comprehension. Neither vocabulary,Show MoreRelatedDeveloping Management Skills404131 Words   |  1617 Pagesonline assessment and preparation solution for courses in Principles of Management, Human Resources, Strategy, and Organizational Behavior that helps you actively study and prepare material for class. Chapter-by-chapter activities, including built-in pretests and posttests, focus on what you need to learn and to review in order to succeed. Visit www.mymanagementlab.com to learn more. DEVELOPING MANAGEMENT SKILLS EIGHTH EDITION David A. Whetten BRIGHAM YOUNG UNIVERSITY Kim S. Cameron Read MoreCommon Knowledge : How Companies Thrive by Sharing What They Know56617 Words   |  227 PagesExpert Transfer 8 Looking Across the Five Types of Knowledge Transfer 9 Building an Integrated System for Knowledge Transfer Notes Index About the Author ix 1 17 33 53 77 99 127 143 161 175 179 187 Page ix Acknowledgments In the course of writing this book many organizations opened their doors to me so I could gain a comprehensive understanding of how they were transferring knowledge. I owe a great deal to the individuals who spent time being interviewed and who paved the way to give me accessRead MoreFundamentals of Hrm263904 Words   |  1056 PagesPART 3 Chapter 5 Chapter 6 Chapter 7 STAFFING THE ORGANIZATION Human Resource Planning and Job Analysis 110 Recruiting 132 Foundations of Selection 154 PART 4 Chapter 8 Chapter 9 TRAINING AND DEVELOPMENT Socializing, Orienting, and Developing Employees 182 Managing Careers 208 PART 5 Chapter 10 Chapter 11 Chapter 12 Chapter 13 MAINTAINING HIGH PERFORMANCE Establishing the Performance Management System 230 Establishing Rewards and Pay Plans 260 Employee Benefits 286 Ensuring aRead MoreBackground Inditex, One of the Worlds Largest Fashion Distributors, Has Eight Major Sales Formats - Zara, Pull and Bear, Massimo Dutti, Bershka, Stradivarius, Oysho, Zara Home Y Kiddys Class- with 3.147 Stores in 70100262 Words   |  402 Pagesfor all your encouragement, your insightful advice, your patience, kindness and all that you have taught me during these years. Thank you also to Hà ¥kan Rodhe, my second supervisor, who has not only provided valuable input related to my research and writing, but who has also been a rich source of advice and inspiration when it comes to many other aspects in life ranging from teaching to parenting. Thank you Hà ¥kan; for your support and for always having a good perspective on what is important in life

Cerebral Palsy - Free Essay Example

Sample details Pages: 30 Words: 9013 Downloads: 9 Date added: 2017/09/21 Category Advertising Essay Type Argumentative essay Tags: Development Essay Did you like this example? I. INTRODUCTION Background and rationale of the study: One of the leading cases of musculoskeletal trauma is fracture. Fractures are any break in the continuity of the bone. It usually occurs when the stress placed on a bone is greater than the bone can absorb. Muscles, blood vessels, nerves, tendons, joints and other organs may be injured when fracture occurs (Nettina, Sandra B. 2006). It can be caused by metabolic bone diseases such as osteoporosis, or as a result of direct force when a moving object strikes the body area over the bone, or it could result from accidental falls. Accidental falls is on top of the list when we talk about fracture causes, and it can happen as a result of lack of balance and poor muscle coordination. It can also happen because of underlying neuromuscular disorders like cerebral palsy. Cerebral palsy includes a wide variety of non-progressive brain disorders that occur during intrauterine life, delivery, or early infancy. It is defined as a sy ndrome of motor disabilities possibly accompanied by mental retardation, seizures, or both. Causes of cerebral palsy are many and include cerebral developmental disorders such as microcephaly, intracranial hemorrhage, cerebral anoxia, and toxins such as excessive bilirubin. Prenatal factors include infection with rubella, nutritional deficiency, and blood factor incompatibility (Bullock and Henze, 2000). One of the most common types of cerebral palsy, that accounts for 50% of all CP cases, is the Spastic cerebral palsy. It has three different subtypes mainly: diplegia, which mostly affects the lower extremities; Quadriplegia, where all four extremities are involved; and lastly Hemiplegia, the most common type of spastic CP and it involves one side of the body. The author of this study chose the above mentioned case because the author would want to make a connection between the two major diseases occurring in one individual, since the occurrence of one would not necessarily mea n the presence of the other. Likewise cerebral palsy patient are thought to be somebody that should be given special attention and care because of the affected individuals inability to perform activities of daily living, and to have a CP patient get injured indicates that there must be some negligence on the part of the direct care giver, who is the mother. Moreover cerebral palsy patients have a high seizure tendency and soft brittle bones due to lack of usage of the extremities contributing to the risk of acquiring injuries such as fracture. With the given information above, the researcher would like to know more about the disease condition and to provide important information to the parents of the child to avoid future injuries. Objectives of the study: This study aims to obtain information regarding Cerebral palsy and closed subtrochanteric fracture of the femur. It as well intends to analyze the diagnostic findings of a patient diagnosed with this condition and to identif y medical and surgical interventions appropriate for this disease. Lastly this study aims to provide holistic nursing care to patients diagnosed with this disease. SPECIFIC OBJECTIVES: †¢ To know conditions that can possibly lead into cerebral palsy and fracture of the femur. †¢ To be able to connect cerebral palsy to the development of fracture and their relationship to each other. †¢ To be able to gather information on medical interventions and surgical interventions available to possibly cure this disease condition. †¢ As a nurse, to enumerate the responsibilities specific to this kind of disease in order to render compassionate and holistic nursing care. Significance of the study: As we all know Cerebral palsy is not a common condition. This means hat nit too many in society know about the disease, while fracture on the other hand is very common. Like for example, at the Vicente Sotto Memorial Medical Center Orthopedics ward. 70% of the censuses are diagno sed with fracture while cerebral palsy only accounted for 0. 5% of the total census for the whole week of June. This study provides the readers information regarding fracture and cerebral palsy since the presence of the latter predisposes the occurrence of the former. It informs regarding the possible causes, signs and symptoms, and corresponding management to avoid and treat the condition. People with this condition will benefit from this study through their health care providers who will be educated on the proper interventions to promote their fast recovery of their fractured femur and to prevent the injury from occurring by eliminating risk factors. The health care providers will profit from this study through obtaining past and current interventions to promote fast healing and recovery of fractures. They will also benefit in terms of knowing the right seizure precautions, to avoid such injuries from happening again during the course of the disease or in the future, when fract ure recovery is already obtained. The study will profit the parent of the patient, since the understudy is a seven year old child and can not read or talk, because it will provide them the right information regarding the child’s condition. It will educate them on the proper precaution that has to be observed in order to avoid injuries if ever seizure episodes of their child occur. Methodology: The study was conducted in Vicente Sotto Memorial Medical Center during a week of exposure at Ward VIII (Ortho Ward). A patient with the name of N. F. S. O. was chosen personally by the student nurse under the guidance of his clinical instructor. She was assisted with her physical, emotional and psychological needs within the next 4 days. Within the allotted time, the patient was rendered with holistic nursing care. The first meeting of the student nurse and patient was devoted to establishing therapeutic relationship in order to gain trust, cooperation and participation from the patient during the course of the treatment. In addition, a physical assessment was also done to obtain baseline data and for the purpose of documentation. This was performed with the aid of the Orthopedic physical assessment form. Following the initial observations, nursing problems were identified. To address the problems recognized, nursing care plans were made to guarantee holistic nursing interventions. The implementation of those plans was reserved to the remaining days of the exposure. Likewise, SOAPIE chartings were done to help test the behavioral outcomes or responses of the patient to interventions done. Then with the support from the clinical instructor who also served as the adviser, the student nurse was guided as to her responsibilities to the patient. Overall, this study is more of evidence on what happened with the activities that have been performed to the patient. And together with the efforts of a multidisciplinary collaboration this study was made possible. II. SITUATIONAL APPRAISAL Patient’s profile: †¢ Name: N. F. S. O. †¢ Age: 7 years old †¢ Sex: Female †¢ Civil Status: Child †¢ Nationality: Filipino †¢ Religion: Roman Catholic †¢ Address: Englis V. Rama, Cebu City †¢ Father: E. O. †¢ Mother: E. T. †¢ Admitting Doctor: Dr. Pia Kareena V. Quinones †¢ Admitting Diagnosis: 1. Fracture Left Subtrochanteric Femur 2. Cerebral Palsy †¢ Admission Date and Time: June 20, 2008: 4:00pm †¢ Hospital Number: 716702 †¢ Diet: Diet as Tolerated †¢ Chief complaint: left leg pain Patient’s History: On June 20, 2008 at around 9-10 AM in the morning patient and his younger brother was playing peek-a-boo, while the mother was washing their cloths, when the brother accidentally sat at the patient’s stroller causing the patient to fall on the floor. And since the patient is a quadriplegic cerebral palsy patient, her left leg was severely bruised. Patient kept on crying and crying even with no movement and manipulation. This prompted the parent’s to admit the child to Vicente Sotto Memorial Medical Center at around 4:00PM. During Assessment mother reported that she had a remarkable prenatal history on the patient, and during her delivery child was intubated @ NICU. And since then child can not walk nor talk. Child has started to exhibit seizure episodes at her 2nd year and 8th month and since then child is being maintained with Phenobarbital 1 Grain. Assessment Findings: Musculoskeletal: There is no muscle coordination. With contractures on the four extremities noted. Pain on the left leg, with some scars on the left foot noted. Patient cannot stand up, nor sit down. She also could not talk, but is able to grasp her feeding bottle. Left and right arm are identical in terms of length and measures 28 cm. While there is a slight deviation in her two legs, as the left is slightly shorter than the right. Left measures 57 cm, whi le the right is at 58 cm. HEENT: Patient’s head is normocephalic with irregular skull contours. There was no mass or lesions noted. Hair is oily with some dandruff. Pupils are round and reactive to light and accommodation, 2mm in size with arcus seniles evident around brown iris, ecteric sclerae. Pale palpebral conjunctiva was noted, no eye discharges. Upon palpation, no edema or tenderness over lacrimal gland and also there was no tearing noted. Pinna recoils after being folded and are aligned with the outer canthus of the eyes. No lesions or discoloration were noted on outer ear. Intact nose bridge at the midline, with slight nasal flaring noted, pink mucosa with cilia, with clear nasal discharges. Sinuses are not tender or painful upon palpation. Thyroid gland is nonpalpable as well as cervical lymhpnodes. Trachea is at midline. Respiratory: Patient has a labored expiration and was breathing at a rate of 32 cpm. Upon auscultation, rales are audible on all quadrants, crackles noted. Chest indrawing is visible during inspiration and expiration. Cardiovascular: Patient’s heart rate is 72 bpm. Apical pulse is audible, clear and without murmurs, with regular rhythm noted upon auscultation. No visible palpitations were noted. Jugular vein distention was not evident. Peripheral pulses were bounding and easily located at dorsalis pedis and carpal areas. Gastrointestinal: Patient has pinkish dry lips without cracks, and white residues in the tongue were noted. Oral mucosa is pinkish, smooth and moist with saliva. She has a total of 24 permanent teeth with visible dental caries. Tongue is pinkish and can move freely, no palpable mass or nodules on surface. Normal bowel sounds, adequately audible on all quadrants with 17 bowel sounds heard in a minute upon auscultation. Upon palpation there is no tenderness or rigidity of the abdomen. Tympani over stomach and bowels, dull sound noted over liver upon percussion. Urinary: Bladder not distended, without pain, urgency and frequency in urination, no flank pain noted. Patient is on diapers. Reproductive: Immature breast noted with no nipple protrusion. Both breasts are equal. Areola is round and darker in color. Nipples are round, and equal in size, no discharges were noted, no cracks. Skin is intact without lesions, masses, striaes and dimpling in both breasts. Labia majora and minora are intact. No discharges and swelling noted. OB- Gyne history: Patient has not had her menarche yet. Neurologic: CN 1: anosmia noted. Patient can not identify odor. CN 2: Patient can not read. CN 3: pupils equally round and reactive to light and accommodation CN 4: there is some unequal movement in both eyes. More like of a strabismus, but it is not that profound. CN 5: equal face sensation, no facial palsy, able to move upper and lower jaw CN 6: patient is unable to move her eyes from one side to the other. CN 7: able to frown, able to smile, able to raise and lower eyebrows, able to close eyelids, able to taste sweet, sour, salty and bitter. CN 8: Patient can not stand up nor sit down, and can not hear voice, at a normal rate, within 5 feet distance. CN 9: Able to taste sweet, sour, salty an bitter, Gag reflex intact as evidenced by ability to swallow CN 10: When patient said â€Å"ah†, upward and downward movement of the palate and oropharynx was noted CN 11: able to flex head but patient was having a hard time shrugging her shoulders due to the present of contractures in both upper extremities. CN 12: Able to stick out tongue to the midline, tongue freely moves inside the oral cavity Patient was unable to perform finger to nose test with difficulty of speech and articulation, with a 0 grade patellar reflexes on lower extremities and 0-grade also for triceps and biceps reflexes on both upper extremities. Psychological: Patient can not talk, stand and sit. Exhibits a blank stare often times, and cries whenever she has problem breathing and when she does not like the food or when she is hungry or feels humid and sleepy. Anatomy and Physiology The femur , the longest and strongest bone in the skeleton, is almost perfectly cylindrical in the greater part of its extent. The femur, like other long bones, is divisible into a body and two extremities [pic] Figure 1-Anterior View of the Femur Upper Extremity (proximal extremity) The upper extremity presents for examination a head, a neck, a greater and a lesser trochanter. The Head (caput femoris) Its surface is smooth, coated with cartilage in the fresh state, except over an ovoid depression, the fovea capitis femoris, which is situated a little below and behind the center of the head, and gives attachment to the ligamentum teres. The cartilage provides smooth articulation. The Neck (collum femoris). The neck is a flattened pyramidal process of bone, connecting the head with the body. The Trochanters. The trochanters are prominent processes which afford leverage to the muscles that rotate the thigh on its axis. They are two in number, the greater and the lesser. The Greater Trochanter (trochanter major; great trochanter) is a large, irregular, quadrilateral eminence, situated at the junction of the neck with the upper part of the body. Tubercle of the femur; it is the point of meeting of five muscles: the Glut? us minimus laterally, the Vastus lateralis below, and the tendon of the Obturator internus and two Gemelli above The Lesser Trochanter (trochanter minor; small trochanter) is a conical eminence; it projects from the lower and back part of the base of the neck. Point of attachment for Psoa’s major. Body or Shaft (corpus femoris). The body, almost cylindrical in form, is a little broader above than in the center, broadest and somewhat flattened from before backward below. [pic] Figure 2- Posterior view of the femur B. The Lower Extremity (distal extremity) The lower extremity, larger than the upper, is somewhat cuboid in form, but its transvers e diameter is greater than its antero-posterior; it consists of two oblong eminences known as the condyles. These condyles at the distal end of the femur articulate with the tibia. Epicondyles, located medial and lateral to the condyles are points of ligament attachment. The patella or knee cap, is located within the major tendon of the anterior thigh muscles and enables the tendon to turn the corner over the knee. [pic] Figure 3- Parasympathetic and Sympathetic Nervous System The Brain Three cavities, called the primary brain vesicles, form during the early embryonic development of the brain. These are the forebrain (prosencephalon), the midbrain (mesencephalon), and the hindbrain (rhombencephalon). During subsequent development, the three primary brain vesicles develop into five secondary brain vesicles. †¢ The telencephalon generates the cerebrum (which contains the cerebral cortex, white matter, and basal ganglia). †¢ The diencephalon generates the thalamus, hypo thalamus, and pineal gland. †¢ The mesencephalon generates the midbrain portion of the brain stem. †¢ The metencephalon generates the pons portion of the brain stem and the cerebellum. †¢ The myelencephalon generates the medulla oblongata portion of the brain stem A second method for classifying brain regions is by their organization in the adult brain. The following four divisions are recognized. [pic] Figure 4- Lobes of the Cerebrum, Sagittal Section of the Brain, and Ventricles of the Brain The cerebrum consists of two cerebral hemispheres connected by a bundle of nerve fibers, the corpus callosum. The largest and most visible part of the brain, the cerebrum, appears as folded ridges and grooves, called convolutions. The following terms are used to describe the convolutions: †¢ A gyrus (plural, gyri) is an elevated ridge among the convolutions. †¢ A sulcus (plural, sulci) is a shallow groove among the convolutions. A fissure is a deep groove among the convolutions. †¢ The deeper fissures divide the cerebrum into five lobes (most named after bordering skull bones)—the frontal lobe, the parietal love, the temporal lobe, the occipital lobe, and the insula. All but the insula are visible from the outside surface of the brain. †¢ A cross section of the cerebrum shows three distinct layers of nervous tissue: †¢ The cerebral cortex is a thin outer layer of gray matter. Such activities as speech, evaluation of stimuli, conscious thinking, and control of skeletal muscles occur here. These activities are grouped into motor areas, sensory areas, and association areas. [pic] Figure 5-The human central Nervous System †¢ The cerebral white matter underlies the cerebral cortex. It contains mostly myelinated axons that connect cerebral hemispheres (association fibers), connect gyri within hemispheres (commissural fibers), or connect the cerebrum to the spinal cord (projection fibers). The corpus callosum is a major assemblage of association fibers that forms a nerve tract that connects the two cerebral hemispheres. Basal ganglia (basal nuclei) are several pockets of gray matter located deep inside the cerebral white matter. The major regions in the basal ganglia—the caudate nuclei, the putamen, and the globus pallidus—are involved in relaying and modifying nerve impulses passing from the cerebral cortex to the spinal cord. Arm swinging while walking, for example, is controlled here Pathophysiology Etiology: †¢ Trauma †¢ Stress and fatigue †¢ Direct or indirect force †¢ Falls †¢ Cerebral anoxia Risk factors: †¢ Metabolic bone diseases, such as osteoporosis Neoplasm †¢ Osteogensis imperfecta †¢ Osteopenia †¢ Postmenopausal estrogen loss †¢ Protein malnutrition †¢ Seizure tendencies Patient’s etiology: Cerebral Palsy and Trauma Cerebral Anoxia v Spastic cerebral palsy v Quadriplegic type static cerebral palsy v Soft and b rittle bones v Trauma v Stress placed on bone exceeds the bone’s ability to absorb it v Break in the continuity of the bone v Muscles attached to the bone are disrupted v Muscles undergo spasm and pull fracture fragments out of position v Distal portion of the femur is displaced v Periosteum and blood vessels in the cortex and marrow of the fractured bone are disrupted v Soft tissue damage v Bleeding occurs from both the soft tissue and from the damage ends of the bone v Signs and symptoms: †¢ pain, †¢ edema, †¢ tenderness of fractured site †¢ abnormal movement and crepitus †¢ loss of function †¢ ecchymoses †¢ visible deformity, †¢ shortening of affected limb †¢ paresthesias †¢ All four extremities are involved. †¢ The individual is non-ambulatory and is not able to acquire speech and no sphincter control. †¢ Contractures on all four limbs III. SUMMARY OF MEDICAL AND SURGICAL MANAGEMENT Diagnostic studies: For fracture and cerebral palsy A. ACTUAL Radiography (X-RAY) is the most widely used non-invasive musculoskeletal diagnostic procedure. X-ray examinations are used to do the following: †¢ Establish the presence of a musculoskeletal problem †¢ Follow its progress †¢ Evaluate the effectiveness of the treatment A palin film is obtained, usually an anteroposterior or lateral view, possibly both. Patient’s X-ray result: The radiograph study was taken last June 20, 2008 to help diagnose the patient’s skeletal condition. The results showed that there was a fracture on the patient’s left subtrochanteric region of the femur. Complete blood count (CBC) Table 1- Complete Blood Count |HEMATOLOGY | |Blood components |Results |Normal value |Unit |Interpretation | |WBC |12. 7 |4. 8 – 10. 8 |10^9/L |Increased | |RBC |4. 2 |4. 2 – 5. 4 |10^12/L |Within normal limits | |Hemoglobin |12. 4 |F= 12. 6 – 16. 0 |g/L |Slightly decreased | |Hematocrit |0. 373 |F=0. 370 – 0. 470 |l/L |Within normal limits | |MCV |87 |81 – 99 |fl |Within normal limits | |MCH |28 |27. – 31. 0 |pg |Within normal limits | |Platelet |302 |150 – 450 |10^9/L |Within normal limits | |Neutrophils |63. 4 |40. 0 – 74. 0 |% |Within normal limits | |Lymphocytes |20. 6 |19. 0 – 48. 0 |% |Within normal limits | |Monocytes |7. |3. 4 – 9. 0 |% |Within normal limits | |Eosinophils |2. 1 |0. 00 – 7. 0 |% |Within normal limits | |Basophils |0. 8 |0. 0 – 1. 5 |% |Slightly increased | This laboratory results on the blood components were obtained last June 20, 2008 as part of the diagnostic exams that the patient has to undergo. All the components’ results were within normal limits, except for the WBC, Hemoglobin, and Basophils. He increased white blood cell (WBC) component signifies that there is a possible infection. While the slightly decreased Hemoglobin may indicated low oxygen supply in the blood due to hypoxia. And lastly, the slight increase in the basophile content is a result of the inflammatory process that the patient is undergoing due to fracture. B. IDEAL Arthroscopy- used to detect if the injury has any joint involvement. A fiberoptic arthroscope allows endoscopic examination of various joints (hip, knee, shoulder, elbow, and wrist) without making a large incision. Arthroscopy can be used for 1) Obtaining a biopsy specimen, 2) assessing articular cartilage, 3) removing loose bodies, and 4) trimming cartilage. It is usually an out-patient procedure performed with the use of local anesthesia. The client recovers more quickly that after an arthrotomy (opening of the joint). Computed tomography (CT) assists in determining the extent of bony destruction, and in better delineating bony architecture. CT will also help in better understanding intralesional calcifications. As with plain radiographs, disappearance or change in the nature of calcifications with re peat scanning can be suggestive of malignancy. Magnetic Resonance Imaging (MRI) – Facilitates the early diagnosis of many conditions that affect tendons, ligaments, cartilage and bone marrow. This is also important in assessing the integrity of the bone. MRI is also indicated and used for cerebral palsy patients since can help identify lesions that may be the cause of seizure for CP patients. Electromyogram is used to assess such problems as muscle weakness, altered gait, and lower motor neuron lesions. It measures and documents electrical currents produced by skeletal muscles, called muscle action potentials. Small-needle electrodes are inserted into muscles. The electrical potentials of each muscle are amplified, transmitted to an oscilloscope, and displayed on a screen. The recording can be made audible and documented on paper. Electroencephalogram (EEG) – is a measurement of the electrical activity of the superficial layers of the cerebral cortex. The electr ical potentials from neuron activity within the brain are recorded in the form of wave patterns. It is helpful in lcating epileptic episodes, spread, intensity, and duration; It can also help classify seizure type since one of the major manifestation of cerebral palsy is seizure. Blood tests are generally not helpful in making the diagnosis, although they can be used to make sure that there is no other process going on, such as infection or any bone malignancy. Source: Black and Hawks. 2005. Medical-Surgical Nursing. Clinical Management for Positive Outcome. Volume 1. 7th edition. Singapore Elsevier. Medical Management ACTUAL Table 2- Drug Summary of Tramadol Hydrochloride |Name of |Classifications |Mechanism |Patient’s |Contraindications |Side | |Drug | |of Action |Indication | |Effects | Nursing Responsibilities: Before: ? Baseline vital signs were taken prior to the giving of tramadol. ? Assessed the type, location and intensity of pain ? Assessed patient’s bo wel function routinely ? Checked patient’s history of hypersensitivity to tramadol. ? Observed aseptic technique in drug preparation ? Checked doctor’s order before administration of tramadol During: ? Observed the RIGHTS in drug administration ? Maintained aseptic technique in drug administration ? Tramadol was administered every 6 hours as prescribed. ? May be administered without regards to meals ? Tramadol 15mg was given via IVTT every 6 hours to relieve pain After: ? Instructed patient’s S. O. n how and when to ask for pain medication ? Cautioned patient’s S. O to avoid from activities that require attentiveness until response to medication is known ? Advised patient’s S. O. to change patient’s position slowly, to minimize orthostatic hypotension ? Cautioned patient’s S. O. to avoid concurrent use of alcohol and other CNS depressants with this medication ? Encouraged patient’s S. O. to turn, cough and let patient breathe d eeply q 2hrs to prevent atelectasis Table 3- Drug summary of Acetaminophen Name of |Classifications |Mechanism |Patient’s |Contraindications |Side | |Drug | |of Action |Indication | |Effects | Nursing responsibilities: Before: ? Assessed vital signs especially temperature ? Assessed fever: note presence of associated signs (diaphoresis, tachycardia, and malaise) ? Monitored patient’s serum bilirubin, LDH, AST, ALT and prothrombin time ? Kept acetylcysteine at bedside ? Explained drug therapy to patient’s S. O. During: ? Administered paracetamol with a full glass of water (for PO use) ? Drug may be taken with food or an empty stomach ? Evaluated patient’s hematologic and hepatic function ? Cautioned patient’s S. O. to avoid patient from taking more on product containing acetaminophen. ? Reassessed vital signs especially temperature After: ? Advised patient’s S. O. to let patient take drug as directed ? Advised patient’s S. O. to avo id patient from intake of alcohol ? Advised patient’s S. O. to consult physician if discomfort or if fever is not relieved ? Instructed patient’s S. O. to inform physician before taking OTC meds Table 4- Drug Summary of Phenobarbital |Name of |Classifications |Mechanism |Patient’s |Contraindications |Side | |Drug | |of Action |Indication | |Effects | Nursing responsibilities: Before: †¢ Assessed patient’s history for hypersensitivity to drugs †¢ Equipment for resuscitation and artificial ventilation are made readily available. Assessed location, and characteristic of seizure activity †¢ Obtained patient’s history before initiating drug therapy †¢ Explained drug therapy to patient’s S. O During: ? Assessed for pain. Drug may increase sensitivity to pain ? Evaluated patent’s hepatic and renal function periodically ? Injections should be given deep into the gluteal muscle ? Tablets were crushed and mixed with food for my patient, since she has difficulty swallowing ? Symptoms of drug toxicity: confusion, drowsiness, dyspnea, slurred speech, and staggering were closely monitored After: Prevented risk for Injury by creating an improvised safety measurements like placing pillow at the side of the bed ? Instituted seizure precaution ? Gradually decreased dose while concurrently increasing dose of replacement drug to maintain anticonvulsant effect ? Advised patient’s S. O. not to discontinue medication without consulting physician ? Advised patient’s S. O. to take medication as prescribed ? Cautioned patient’s S. O. to avoid intake of alcoholic beverages ? Cautioned patient’s S. O. to avoid activities requiring focus. Table 5- Drug Summary of Amoxicillin Trihydrate Name of |Classifications |Mechanism |Patient’s |Contraindications |Side | |Drug | |of Action |Indication | |Effects | Nursing responsibilities: Before: ? Assessed for infection (vital signs, wound appe arance, sputum, urine, stool and WBC’s) ? Assessed patient for hypersensitivity to Amoxicillin ? Obtained patient’s medication history, before initiating therapy ? Specimens for culture and sensitivity were obtained. ? Explained drug therapy to patient’s S. O. During: ? Observed for signs and symptoms of anaphylaxis. ? Kept epinephrine, antihistamine, and resuscitation equipment at bedside. ? Monitored hgb, hct, RBC, WBC, neutrophils, and lymphocytes. ? Added mineral water for oral suspension to each 50mg/ml bottle. ? Administered only clear solutions. After: ? Advised patient’s S. O. to report signs of superinfection and allergy. ? Instructed patient’s S. O. to comply with drug regimen. ? Instructed patient’s S. O. o report immediately to physician if diarrhea and fever occurs. ? Instructed patient’s S. O. to notify physician if symptoms do not improve ? Checked and assessed patient’s vital signs after drug administration. IDEAL Therapeutic Interventions 1. Emergency management includes splinting fracture above and below site of injury, applying cold, and elevating limb to reduce edema and pain 2. Control bleeding and provide fluid replacement to prevent shock, if necessary 3. Traction used for long bones 4. Skin traction force applied to the skin using foam, rubber, tapes, and so forth 5. Skeletal traction – force applied to the bony skeleton directly, using wires, pins, or tongs placed into or through the bone 6. External Fixation to stabilize complex and open fracture with use of a metal frame and pin system. Source: https://www. wheelessonline. com/ortho/femoral_shaft_fracture. Management of Femoral Fractures. Accessed last September 25, 2008. Pharmacological Interventions: 1. Local anesthetics, opioid analgesics, muscle relaxant, or sedative is given to assist the patient during closed reduction procedure 2. Closed reduction may also be done with general anesthesia 3. Analgesics are given as directed to control pain postoperatively Source: https://www. wheelessonline. com/ortho/femoral_shaft_fracture. Management of Fractures. Accessed last September 25, 2008 Surgical Management: IDEAL Open reduction and Internal Fixation (ORIF) – To perform open reduction, the surgeon makes an incision and realigns the fracture fragments under direct visualization. Open reduction is usually performed in combination with internal fixation for femoral and joint fractures. Screws, pins, plates, wires, or nails may be used to maintain alignment of fracture fragments. After wound closure, splints or casts may be used for additional stabilization and support. External Fixation – Depending on the client’s condition and the physician’s judgment, external fixation devices may be used for fracture fragment immobilization. Source: Black and Hawks. 2005. Medical-Surgical Nursing. Clinical Management for Positive Outcome. Volume 1. 7th edition. Singapore Else vier. ACTUAL No actual surgical interventions done. IV. PROBLEM ANALYSIS 1. Impaired Physical Mobility related to musculoskeletal impairment secondary to left subtrochanteric fracture of the femur. The patient can not stand, walk, and even sit down without assistance. She can not move her left leg because of fracture. †¢ Impaired physical mobility is defined as a limitation in independent, purposeful, physical movement of the body or of one or more extremities (Doenges, et. al. 333). 2. Risk for injury related to uncoordinated large and small muscle contraction secondary to permanent physical disability, cerebral palsy. †¢ The patient has cerebral palsy with seizure tendencies. Patients with seizure tendencies are always at risk for injury. Just like how the patient got her fracture. At risk of injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources ( Doenges, et. al. 312). †¢ A Seizure is a sudden, abno rmal electrical discharge from the brain that results in changes in sensation, behavior, movements, perception or consciousness (Black Hawks. 2077). 3. Risk for impaired skin integrity related to immobility of left leg secondary to left subtrochanteric fracture of the femur. †¢ The patient had been confined to bed rest for almost 2 weeks already, and because oh her inability to move and turn from one side to the other. She is placed on a great risk of developing bed sores or skin ulcers. †¢ Risk for skin integrity is someone at risk for skin being adversely altered ( Doenges, et. al. 417). 4. Health seeking behavior: proper care of a cerebral palsy patient related to lack of experience. †¢ The patient’s S. O. made herself available for help through health teaching regarding the proper care for her daughter with cerebral palsy and fracture. †¢ Health seeking behavior is defined as active seeking of ways to alter personal health habits and/or the environ ment to move toward a higher level of health (Doenges, et. al. 278). 5. Self-care deficit: bathing and hygiene related to physical immobility secondary to quadriplegic cerebral palsy. †¢ The patients is suffering from quadriplegia or loss of muscle coordination in all four limbs of the body, thus preventing the patient from performing body hygiene activities such as bathing and brushing the teeth. †¢ Self-care deficit, hygiene, is the impaired ability to perform feeding, bathing, dressing, and grooming or, toileting activities for oneself. Self-care may also be expanded o include the practices used by the client to promote health, the individual responsibility for self-care, a way of thinking (Doenges, et. l. 268). V. DECISIONAL ANALYSIS: NCP 1 Nursing Diagnosis: Impaired physical mobility related to musculoskeletal impairment secondary to left subtrochanteric fracture of the femur. Subjective Cues: No verbal cues noted Objective Cues: †¢ Without IVF †¢ With t he ff. Vital signs: T= 37. 2 Celsius; P= 118 bpm; R= 24 cpm †¢ Physical immobility noted †¢ With balance traction †¢ Humming noted Laboratory: †¢ Radiograph results show a break in the subtrochanteric region of the left femur. †¢ Ideal: results of arthroscopy and X-ray Theoretical Basis: Impaired physical mobility is defined as a limitation in independent, purposeful, physical movement of the body or of one or more extremities (Doenges, 333). †¢ Manifestations of fracture include pain at site of injury, swelling tenderness, false motion and crepitus (grating sensation), deformity, loss of function, ecchymosis, and paresthesia (Nettina, Sandra M. 2006. p. 1079). †¢ A radiograph may confirm the bone injury, but it does not show evidence of the torn muscle or ligaments, severed nerves, or ruptured blood vessels that can complicate the client’s recovery (Nettina, Sandra M. 006. p. 1079). Expected Outcome: †¢ Short term goal: After 8 hours o f nursing intervention patient’s S. O. will be able to verbalize understanding of the situation/ risk factors and individual treatment regimen and safety measures. †¢ Long term goal: After 40 hours of nursing interventions patient’s S. O. will be able to maintain the patient’s position of function and skin integrity as evidenced by absence of decubitus ulcers and foot drops. Intervention and rationale: A. Independent 1. Determine diagnosis that contributes to immobility R: to identify causative factors (Doenges, et. al. 335). 2. Perform physical assessment while doing tepid sponge bath. R: doing sponge bath is the best way to assess your patient (Kozier ,et. al. 706). 3. Assess patient’s physical and mental status. R: To determine patient’s level of consciousness (Kozier, et. al. 528). 4. Note emotional / behavioral responses to problems of immobility. R: Feelings of powerlessness/frustrations may impede attainment of goals (Doenges, et. al . 335). 5. Instruct patient’s S. O. in use of side rails, overhead trapeze, and roller pads. R: For position changes and transfers (Doenges, et. Al. 335). 6. Support affected body part using pillows and foot supports R: To maintain position of function and reduce risk of pressure ulcers (Doenges, 335). 7. Encourage adequate intake of fluids about 8 -10 glasses per day, and eat nutritious foods. R: Promotes well-being and maximizes energy production. Reduce risk for renal calculi formation and constipation (Doenges, 335). 8. Raise side rails up. R: Proper techniques prevent further injury and promote seizure precautions (Doenges, et. al. 335). B. Dependent/Collaborative . Administer pain medications as indicated. R: To relieve pain (Doenges, et. al. 335). 2. Elevate head of bed. R: To promote maximum comfort and resting satisfaction on the child (Black Hawks. 604). 3. Administer anti seizure and anti-convulsant drugs, as prescribed. R: To prevent and avoid seizures and dec reasing the risk for further damage and injury on the child (Black Hawks. 2018). At the end of the shift, the patient’s was noted for compliance of the medications. She verbalized willingness to participate in activities that will prevent the complications stated above. She was seen placing pillows on the patient’s side and verbalized that she religiously gave Phenobarbital to her daughter before going into bed, of course with the supervision of the nurse on duty. NCP 2 Nursing Diagnosis: Risk for injury related to uncoordinated large and small muscle contractions, secondary to cerebral palsy. Subjective cues: no verbal cues noted. Objective cues: †¢ Without IVF †¢ With balance traction †¢ No side rails noted †¢ Seizure episodes and tendencies reported by the S. O. †¢ Inability to talk observed †¢ Drooling eyes noted. Laboratory: †¢ NO significant laboratory result Ideal: EEG, MRI and Ct scans to confirm the cause of seizure episo des Theoretical basis: †¢ At risk of injury as a result of environmental conditions interacting with the individuals adaptive and defensive resources (Doenges, et. al. 314). †¢ A seizure is a sudden, abnormal electrical discharge from the brain that results in changes in sensation, behavior, movements, perception or consciousness. A seizure may occur in isolation or with some acute problem within the central nervous system, such as low blood glucose level, drug or alcohol withdrawal, or traumatic brain injury (Black and Hawks. 077). †¢ The goals of management of client’s with seizures and epilepsy are to prevent injury during seizures, to eliminate factors that precipitate seizures, to diagnose and treat the cause of the seizures, and to control seizures to allow a desired lifestyle (Black and Hawks. 2077). Expected Outcome Criteria: †¢ Short term goal: After 8 hours of nursing intervention the patient’s S. O will verbalize understanding of individu al factors that contribute to possibility of injury and take steps to correct situation. †¢ Long term goal: After 2 days of nursing intervention the patient’s S. O. ill be able to free the patient from any injury. Intervention and Rationale: A. Independent 1. Assess patient’s physical and mental status. R: It shouldn’t only the physical aspects are assess, but also the intellectual and mental state (Doenges, et. al. , 332). 2. Not age and sex. R: Children, young adults, elderly persons and men are at greater risk (Doenges, et. al. 311). 3. Assess mood, coping abilities, personality changes. R: May result in carelessness without consideration of consequences (Doenges, et. al. 311). 4. Provide information regarding disease condition that may result in increased risk of injury. R: Giving information increases knowledge about a topic or let the client know what to expect and to prevent injury (Kozier, et. al. 277). 5. Raise side rails up or put a pillow on t he side of the bed. R: To prevent the patient from falling out of her bed (Doenges, et. al. 311). 6. Stay at patient’s bedside. R: To note and observe possible signs of an upcoming seizure episode (Black and Hawks. 499). 7. Teach patient’s S. O. on the possible signs and manifestations that may prelude to a seizure attack. R: To promote awareness when the nurse is not around (Black Hawks. 1477). 8. Provide bibliotherapy and written resources R: For later review and self-paced learning (Doenges, et. al. 312). B. Dependent/Collaborative: 1. Administer drugs as prescribed, such as Phenobarbital. R: Phenobarbital inhibits and helps prevent convulsion from happening (Black Hawks. 2077). 2. Place all sharp objects away from patient’s bedside. R: To avoid accidental injuries if ever seizure occurs (Doenges, et. al. 473). 3. Place patient in a supine position with bed lowered down. R: Supine position is the ideal position for patient’s risk for seizure attac ks (Black Hawks. 2079). At the end of the shift patient’s S. O. placed patient in supine position, and stayed at bedside. She also placed a pillow at the side of the bed and freed the bedside table from any sharp objects, including fork and knife. Patient took Phenobarbital before bedtime. And lastly the patient was free fro injury. DISCHARGE PLANNING: Probable date: August 8, 2008 Destination: Englis V. Rama, Cebu City Transportation: Taxi or public utility vehicle/ jeepney Agencies and equipment involved: †¢ Vicente Sotto Memorial Medical Center Ward VIII †¢ All equipments used in the diagnostics Diet: †¢ a low salt low fat diet yet high in carbohydrates, proteins, vitamins and minerals in order to sustain the patient’s metabolic needs. High in calcium to promote fast recovery and bone healing. Medications: 1. Continue medications as prescribed by the physician; 2. Emphasize the importance of strict medication compliance, especially Phenobarbital. Persons responsible for patient: 1. Dr. Pia Kareena V. Quinones – the physician in charge should give the patient final instructions before leaving the hospital, especially regarding the patient’s seizure tendencies and fracture 2. Staff nurses – help in facilitating the patient’s discharge slip and also give some health teachings that are useful when the patient is at home 3. Family members – to receive the patient and take her home. They will also be listening to health teachings to assist in the needs of the client in the absence of the doctors or the nurses Family conference: 1. Encourage family members to assist client in her needs 2. Emphasize that patient will require more rest than before and caution family members to provide added caution in preventing injury, like never leave the patient alone with her siblings. 3. Advise to provide patient lifestyle modifications and avoid excessive environmental stimulation. Also advise family member s to provide adequate nutrition and rest to avoid exacerbation. . Inform that their presence and unconditional support will be of great help to the patient especially during the recovery of the patient’s injury. 5. Anticipated problems: 6. Instruct to watch out for signs and symptoms of infection such as increase temperature, weakness, malaise, rapid respiration and pulse rate. If noted inform them to bring patient immediately to the nearest health agency 7. If bone pain occurs or other unusual signs will be observed refer promptly to the hospital. 8. Instruct patient to always practice minimizing environmental stimulation protocol at all times. To decrease the risk of seizure occurrence. . Emphasize regular follow up examination to monitor progress of disease. Home visit: †¢ Check on patient’s health status once every week especially after cast is removed from the fractured leg. (If patient is undergoing one). †¢ Provide ample assistance and support SOAPIE C HARTING: SOAPIE 1 Subjective cue: No verbal cues noted. Objective cues: o Received on bed, awake, conscious and coherent o Without IVF o With balance traction on left leg o Guarded movements noted o Unable to move left leg Assessment: Impaired Physical mobility related to musculoskeletal impairment secondary to fracture on the subtrochanter of the left femur. Plan: After 8 hours of nursing interventions patient’s S. O. will be able to verbalize understanding of situation, risk factors and individual treatment regimen and safety measures. Interventions: o Established rapport o Assessed skin color, integrity and temperature of the affected leg o Provided tepid sponge and bath o Did physical assessment o Provided with adequate rest periods o Supported affected body part using pillows o Instructed patient’s S. O regarding the use of side rails, overhead trapeze, and roller pads o Emphasized strict medication compliance o Encouraged S. O. to increase patient’s flu id intake Provided seizure precautions o Vital signs taken and charted o Environmental care done Evaluation: â€Å"Salamat dong, kahibaw nako unsaun pag atiman ako anak†, as verbalized by S. O. SOAPIE 2 Subjective Cue: No verbal cues noted Objective Cues: o Received on bed lying awake, conscious and coherent o Without IVF o With balance traction on left leg o No side-rails noted o Seizure tendencies noted o Blank stare observed o Inability to talk observed o Drooling eyes noted Assessment: Risk for injury related to uncoordinated large and small muscle contractions, secondary to cerebral palsy. Plan: After 8 hours of nursing interventions patient’s S. O. will be able to verbalize understanding of individual factors that contribute to possibility of injury and take steps t correct situations. Interventions: o Assessed physical and emotional status o Instructed Patients S. O. to provide aspiration precaution especially when feeding the patient o Entertained clarificat ions and questions bout seizure precautions o Encouraged S. O. to religiously give Phenobarbital, an anti-seizure drug o Advised increase in fluid intake o Minimized environmental stimulation o Placed pillow at patient’s side Removed all sharp objects from patient’s bedside table o Stayed at patient’s bedside o Place patient in supine position o Taught S. O. on the possible signs that may prelude to a seizure attack o Provided tepid sponge bath o Vital signs taken and recorded o Bed side care done o Environmental care done Evaluation: â€Å"Anaun ra day dong paglikay and digrasya, labi na sa pareha sa akong anak na mukalit lang ug convulsion† as verbalized by S. O. o Pillow at patient’s side o S. O. at patient’s bedside o No sharp objects at bedside table o Patient in supine position SOAPIE 3 Subjective Cue: No verbal cues noted Objective Cues: o Received on bed lying awake, conscious and coherent o Without IVF o With balance traction on left leg o With the following vital signs: T=37. 2 C; R= 24 cpm; P= 118 bpm o Physical immobility noted o Drooping eyes noted o Dirty hands noted o inability to turn from side to side observed Assessment: Risk for impaired skin integrity related to prolonged bed mobility secondary to fracture on the subtrochanter of the left femur Plan: After 8 hours of nursing interventions patient’s S. O. will be verbalize understanding of treatment and regimen therapy. Interventions: Assessed patient’s physical and mental status o Massaged bony prominence gently to avoid friction when moving client o Changed positions bed on a regular schedule o Provided S. O. a turning schedule for the patient o Encouraged S. O. to follow the turning schedule religiously. o Provided pads, pillows, and foam mattresses o Inspected the skin surfaces and pressure points routinely o Administer pain medications o Emphasized to S. O strict medication compliance is very important o Assisted in changing pos itions o Provided adequate rest periods to prevent fatigue o Vital signs taken and recorded Bed side care done o Environmental care done Evaluation: â€Å"Kinahanglan gyud day to nako kay mao man to ang saktong paagi para maayo si inday ug dili masamad ang yang panit† as verbalized by S. O. DISCHARGE SUMMARY A case of N. F. S. O. , 5 years old, female, single, a Roman Catholic from Englis, V. Rama Cebu City was admitted at Vicente Sotto Memorial Medical Center with the chief complaint of left leg pain. Subjective cue: â€Å"Maka-uli na gyud intawn mi pero unsaun man nako pag-atiman si inday para dili mugrabe, ug d I na mausab ang nahitabu† as verbalized by S. O. Objective Cues: Received in bed lying awake, conscious, and coherent o seen SO packing their things o beddings are arranged o bedside table cleaned o frequent asking of questions from S. O. noted o attentiveness noted o eye to eye contact with the S. O. observed Assessment: Health-Seeking Behaviors: request for information regarding proper care of fracture with cerebral palsy related to unfamiliarity with the situation and lack of experience. Plan: After 30 minutes of nursing care patient’s S. O. will be able to verbalize the proper way to care for a patient with cerebral palsy and is rehabilitating from a fractured left leg. Interventions: o Emphasized strict compliance to medications as ordered. Phenobarbital before going to bed o Encourage passive range of motions on unaffected extremities during the same time of the day, preferably in the morning o Taught S. O. how aid patient in perform isometric exercises to enhance muscle strength and prevent wasting o Informed of the available treatment for fracture o Taught S. O. to check cast from time to time, and avoid cast from getting wet. o Referred to community resources o Advised S. O. to provide bed bath everyday o Taught S. O. o provide lifestyle modifications for the patient o Instructed S. O. not to leave the patient alone w ith her younger sister o Instructed to watch out for signs and symptoms of infection such as fever, increase respiratory rate, and heart rate and report immediately to physician if observed o Emphasize the importance of check-ups regularly to monitor health status o Encouraged a well-balanced diet to foster to energy and metabolic requirements o Advised to pray everyday and ask for guidance and good health and to never lose hope. o Emphasized to the S. O. ever ever to forget to thank God for all the graces they have received from him. Evalution: â€Å" Ako gung ampingan mau si inday nurse ug akong ihatag akong best na dili na mausab ang nahitabu para napud maayu ug dali akong anak â€Å" as verbalized by S. O. VI. CONSLUSION AND RECOMMENDATION Conclusion Encountering a patient diagnosed with fracture and cerebral palsy at the same time could be very intriguing, especially if the one diagnosed can not even pronounce the word mama and papa. It is a very sad situation for someone wit h cerebral palsy, a disease condition that should be given extra care and attention, confined in an Orthopedics ward. This phenomenon could actually make anybody an instant agent, trying to dig dipper to the case, Instead of just focusing on the patient’s diagnosis. The patient is diagnosed with a fractured left subtrochanter femur, and cerebral palsy at the same time. This actually resulted when she fell off her crib, and since she has problems with balance it immediately resulted into fracture. Fracture is very common and very curable, given the right treatment, the patient’s normal functioning can return to its normal state. A lot of bone reconstructing surgeries are available; including Open Reduction with Internal Fixation, and Open Reduction with External Fixation. There are also non-surgical treatments including the closed reduction methods such as leg casts and skeletal and skin tractions. But cerebral palsy is totally the opposite when it comes to curabi lity. Cerebral palsy is a very rare condition. It is a series of non-progressive brain disorders in the intrauterine life, delivery or early infancy that is characterize by motor disabilities accompanied by mental retardation and seizure disorders. In my patient’s case it is the spastic type, more specifically the spastic quadriplegia. Meaning all four limbs is greatly affected. Patient with this disorder is unable to acquire speech, and balance, which means they need special treatment and care. And for a 5 year old cerebral palsy patient admitted in the Orthopedics ward of Vicente Sotto Memorial Medical Center due to fracture, primary health care giver should undergo a lot of counseling regarding proper care of their CP child. Health care providers, such as nurses and doctors, goal is to promote the fast recovery from injury and to avoid further accidents by ensuring proper seizure precautions is observed. Since patients with cerebral palsy have a very high seizure ten dency. Proper health education to the parents and family members is very crucial. And the nurse carries the pressure in assuring that the right information regarding the patients treatment is relayed to the family. Therefore prenatal check-ups and right nutrition during pregnancy should be given a high priority. As we can see, the occurrence of one condition was a result of the other. The patient’s disorder could have been prevented if strict prenatal compliance was just observed, and her injury could not have happened if not for her disorder. And lastly she could have been running around, playing with her friends while shouting the name of her mom and dad if not for her condition. Let’s not take cerebral palsy patient for granted. Let’s take care of them and give the treatment they truly deserve. Recommendation To the nursing students: It is already given that nurses are full of energy and optimism; therefore it is only empirical that they hold the responsib ility of injecting vigor to the patients. They should always keep in mind that their main goal is to facilitate recovery and promote wellness. Encouraging these patients to stay positive is very important, considering the kind of trauma and emotional meltdown these patients undergo during the course of the disease. Help them to remain optimistic by cheering them up, and acknowledging every progress they make in their condition. Lastly, as much as possible use the time wisely and exhaust every resource that will be of assistance to these patients. And remember always that honesty is still the best policy. Be honest to yourself, to God, and to your job. To family and relatives: It is important for them to show their support and empathy to the patient. It is a reality that some patients react to their disease condition outrageously. Family members should understand that this reaction is only normal and that they should continue to show their love and support to the patient. Moreo ver the family’s presence alone is already enough to assure the patient that he is not alone in facing the problems that his disease may bring. To the government: Health is wealth and for whatever reasons the health of the Filipino people should not be the least priority. A patient with such disease confined at Vicente Sotto Memorial Medical Center, a public hospital, needs extra attention and care. Just by considering the fact that the hospital lacks the medical equipments and has shortage of manpower, it could not be deny that there is a very big possibility that the patients condition will worsen during the course of treatment. This is a health issue that the government can not afford to ignore. They should address this problem immediately, or else cases of nosocomial infection and other hospital facility related problems will go up. To the patient: It is important for her to follow religiously the instructions of the doctor regarding the patients care. She needs to remember that all the health care professionals’ efforts of helping them will be of no use if they will not cooperate and comply with the treatment. And lastly it is vital for her to always keep in mind that she is still young and that all of these are only trials of life and it is up to her now how she will take it. But of course, rest assured she won’t be alone in facing these hardships. BIBLIOGRAPHY: BOOK SOURCES: †¢ Black and Hawks. 2005. Medical-Surgical Nursing. Clinical Management for Positive Outcome. Volume 1. 7th edition. Singapore Elsevier. †¢ Bullock Henze. 2000. Focus on Pathophysiology. Philadelphia. Lippincott Williams Wilkins. †¢ Doenges et. Al. 2002. Nursing Care Plans. Guidelines for Individualizing Patient Care. 6th Edition. Thailand. F. A. Davis Company. †¢ Doenges et. Al. 2004. Nurses Pocket Guide. Diagnoses, Interventions, Rationales. Thailand. F. A. Davis Company. †¢ Venzon, Lydia M. 2006. Introduction to Nursing Re search: Quest for quality Nursing. 1st edition. Quezon City, Philippines. C E Publishing, Inc. Kozier et. Al. 2004. Fundamentals of Nursing. Concepts, Processes Beliefs. California. Prentice Hall. †¢ Marieb, E. M. 2003. Essentials of Human Anatomy Physiology. 7th edition. California. Pearson Education. †¢ Nettina B. Sandra. 2006. Lippincott Manual of Nursing Practice. Volume 1. 8th edition. Philadelphia. Lippincott Williams Wilkins. †¢ Speer, K. M. 1999. Pediatric Care Planning. Now W/ Clinical Pathways. 3rd edition. Pennsylvania. Springhouse Corporation. INTERNET SOURCES: †¢ https://en. wikipedia. org/wiki/Femur. Femur. Accessed last September 15, 2008 †¢ https://en. ikipedia. org/wiki/Human_brain. Human Brain. Accessed last October 9, 2008 †¢ https://www. wheelessonline. com/ortho/femoral_shaft_fracture. Management of Femoral Fracture. Accessed last September 25, 2008 APPENDICES CURRICULUM VITAE PERSONAL PROFILE Name: Wrygg Blyken Bauer R. Timbal Address: 414 Upper Lipata Minglanilla, Cebu Age: 20 Sex: Male Status: single Nationality: Filipino Birth date: January 5, 1988 Birthplace: Sacred Heart Hospital, Cebu City EDUCATIONAL BACKGROUND: Elementary: Year: Immaculate Heart of Mary Academy Minglanilla, Cebu1995-1998 Intermedaite: Don Bosco Technology Center Punta Princesa, Cebu City1998-2001 Secondary: Don Bosco Technology Center Punta Princesa, Cebu City2001-2005 Tertiary: Cebu Normal University Osmena Blvd. , Cebu City2005-present ACHIEVEMENTS Elementary: Grade 6 †¢ Graduated as Student with Distinction Honors. Ranked 8 of the whole batch. †¢ Member of the basketball team that won the Jubilee League Championship in 2001. 1st time for Don Bosco since 1994. Secondary: Academics †¢ Graduated as a Student with Distinction Honors in Don Bosco Technology Center for the academic year 2004-2005. Sports: BASKETBALL: 2001-2002: †¢ Member, Midgets Division, 1st Runner-up, 1st Boscolympics held @ Don Bosco Technical Institute, Makati City, Philippines. 2002-2003: †¢ Finals MVP, Champion, Math Week 3 on 3 street ball challenge. 2003-2004: †¢ Member, Champion, 1st ML KWARTA PADALA, Interschool Championship; Cebu City †¢ Mythical team member, 2nd runner-up, 3rd Boscolympics held @ Don Bosco Technical Institute, Makati City, Philippines. 2004-2005: †¢ Member, 1st Runner-up, secondary division in basketball, 4th Cebu Schools and Athletics Foundation Incorporation (CESAFI). Member, Champion, secondary division in basketball, 2004-2005 Cebu City Olympics, Cebu City Sports complex. †¢ Member, Champion, secondary division in basketball, 4th Boscolympics held @ Don Bosco Technology Center, Punta Princesa, Cebu City. †¢ Member of Team Cebu City, Champion, secondary division in basketball, Central Visayas Regional Athletic Association, held @ Dumanjug, Cebu. †¢ Member of Team Region 7, 1st Runner-up, secondary division in basketball, Palarong Pambansa held @ Il o-ilo Sports Center, Ilo-ilo City, Philippines. [pic] Don’t waste time! Our writers will create an original "Cerebral Palsy" essay for you Create order