The Role of Women (Duddy Kravitz)

1) What is the role of women in the novel? Make specific references to female characters. What does this tell us about the Kravitz world? In Mordecai Richler’s novel, The Apprenticeship of Duddy Kravitz, women are represented to have a lower class than men. The women who are present in the novel include Yvette Durelle, Ida Kravitz, Minnie Kravitz, Linda Rubin and Sandra Calder. Each of these female characters are seen as helpless individuals unable to bear for themselves and left unsuccessful without men. Through Duddy’s never ending quest to own land to ultimately be successful, Richler depicts women in a negative way.They are seen as instruments to help men succeed and every so often used as traps for others. Therefore the women in this novel do not have lives of their own as they are portrayed solely as part of other men’s lives. Such exists because the lives of the women were not once explored throughout the novel, it was always through the eyes of a man and since the women are not explored, therefore this results in a male dominated novel. Women are portrayed to be items of sexual desires; worthless and unworthy of a man’s second thoughts. As was the case with Max, his wife and Josette.Josette is one of the whores whom Max is pimping for and is described as being a â€Å"handsome whore with splendid black hair and enormous breast. †(22) Such indicates that she is revered only for looks and her sexual abilities. Another such instance is when a women was being described by Max only for her features while they were at the bar â€Å"†¦sitting beside him is the greatest little piece you ever saw. Knockers? You’ve never seen such a pair. I mean just look at that girl†¦Ã¢â‚¬  (20) Furthermore, Josette’s feelings are disregarded and ignored even though she is human and has every right to be treated fairly and humanely.Max grabs her forcefully and practically drags her. â€Å"You’re hurting me â⠂¬ ¦Ã¢â‚¬  (24) She is thought to be someone who can only perform sexual tasks and the readers read that she has no place in society outside or other than that. Max’s poor treatment of his whores, Josette included, likely influenced Duddy’s poor opinion of women. The way he regards women and the way he is with them is reminiscent of his father being a pimp and man-handling Josette at the beginning of the novel, as such treatment has likely been occurring since the death Max’s wife and Duddy’s mother Minnie Kravitz, if not starting with his treatment of her.In sense, it could be argued that Max disrespects his deceased wife by resorting to pimping, using Josette as an instrument to pay for the bills and having a successful family. This revels that Max does not possess the feelings a man should have for his wife. There were types of woman seen in the novel which were those who could not be trusted because they were only out for themselves. Such women were not treated well and are to be hated and laughed at for their stupidity. One of such women, Linda is featured very briefly during Duddy’s time at Hotel Lac des Sables, who Irwin Shubert convinced to go out with him.She is described in great detail; with more attention on her appearance and no mention whatsoever of her having a personality or feelings at all. â€Å"Soft, curvy, and nifty enough for one of those fashion magazines†¦Ã¢â‚¬  (78). She uses him and is still thought to be more worthwhile than the caring Yvette, and is thrown around later on. Sandra is the girl Lennie attempts to perform an abortion for, and consequently nearly loses his place at school. Her father is on the board for the university and he can convince the board to allow Lennie to stay.She is only depicted as being weak and whore-ish, being impregnated by her boyfriend, Andy Simpson. Not much is known about her, but she is seen as being emotional, desperate and hysterical. Riva Kaplan is Lennie ’s girlfriend and though much is not known about her either she is said, by him to be quite the terrible person. â€Å"She’s not better than a whore† (186). He fights with her and she is not mentioned again, indicating that a woman who fights and stands up for herself against a man is to be left and disposed of, not reasoned with or listened to. Furthermore, Duddy was never fully loved by his family.There is no concrete evidence that shows any of them ever cared for him or wanted to take part in his life. Though Lennie seems to somewhat appreciate Duddy, he is still somewhat distant to him and he focuses on his own studies and life. The first person to truly love him, for who he was, unconditionally, was his â€Å"Girl Friday†, Yvette Durelle. She is treated and shown to be beneath the men she is around, and is to be dominated and ordered around without defiance. Duddy’s girlfriend, Yvette, was the first person, male or female, to ever truly love D uddy for who he was, faults and all.Yvette gave Duddy many chances to be with her, but he consistently turned to his desire for land and money in place of her. â€Å"Three weeks. Duddy, if you start running again, I’ll leave you† (291). The last chance she gave him he ignored, and he preferred to stay alone and unhappy (whether conscience of it or not) with his precious land than the woman who loved him. The only time Duddy seems to show any feelings of affection towards Yvette was shorty after they had relations, just before he was shown the land by her.Her purpose to him then was clear; she would be used for sex and for the acquisition he his precious land. The fact that she stayed with him through his emotional abuse towards her indicated that she was weak and subservient, as all women are to be. His inability to appreciate women can be traced to his opinion of himself, his family, or both simultaneously. Specifically concerning Duddy Kravitz, many women were portra yed as traps, nags and instruments helping him succeed. There was woman in particular who helped Duddy to exponential levels and who ultimately led him to be ‘successful’.Yvette never lived in her own right or more than the foil for Duddy’s ambition, which in the end, consumes everything else in the novel. Therefore Yvette’s portrayal is entirely dependent on Duddy. (Richler never explores her family in Montreal) Yvette is seen as a trap to Duddy, despite wanting to pursue his land, he does not want to commit to Yvette and be trapped by her. She does not want Duddy to fulfill his dreams because she would rather settle down and start a family. Consequently Duddy’s lack of interest in Yvette is shown when â€Å"I feel so good, she said.Do you feel good? He could watch the lake over her shoulder and in his mind’s eye it was not only already his but the children’s camp and the hotel were already going up† (Richler, 100) As a nag, Yv ette constantly suggest her opinion to Duddy; as a result this frustrates him and her â€Å"I’ve seen you do lots of dishonest thing, Duddy, but never in my life did I expect you to cheat a boy like Virgil† (216) Duddy’s French Canadian girlfriend, Yvette functioned not as a person in her own right but simply as a moral conscious for Duddy.This shows that Yvette acts as authority figure in Duddy’s life, something he lacks. Yvette also acts as a mother figure in Duddy’s life. Duddy does not show an interest in Yvette; although she harasses him constantly and keeps showing her affection, it irritates Duddy because he is just using her. Yvette is used as an instrument as although she shows genuine love for Duddy, he never seems to have feelings for her.Since Duddy is a minor he employed Yvette as tool in acquiring his land, and manipulates her to his liking. She is an instrument used to get Duddy his land so he can fulfill his dream. Such goes to say that women during the 1950s were to be disregarded and called upon only for tasks, relations and served only as indicators of a man’s wealth and worth by her attractiveness.

Animal Farm Lies=Failure

To have a functional society there must be a trust between the people and the government. A functional society is defined by how they treat their people, if they lie their people will not respect them. Due to the fact that the government in 1984 and Animal Farm lie to their citizens, their societies are a failure. In 1984 the government says that its citizens are free to do what they want but that is a lie. This is because the people actually live in constant fear of telling the facts due to the fatal consequences that would follow.O’Brien says, â€Å"Freedom is the freedom to say two plus two makes four, if that is granted all else follows†(69; Bk1, ch. 7). The citizens in 1984 are in constant fear of saying the wrong thing and getting shot which is not the definition of a free though society. A free thought is where people can think what they want without the fear of getting in trouble. As it shows in 1984 when someone has a thought they have to keep it in or they wil l be imprisoned. This is the definition of a non-successful society.If the government can lie to its people nothing will ever change and nothing will have the chance to get any better. If someone is naive of the fact that there was a better time in history before the dictatorship they see the present as better then before. Due to the falsifying of documents of history in 1984 it seems as though the party is the best to all of the people and that they are getting better, when in all actuality that is not the case. Winston says,† If the party could thrust its hand into the past and say this or that event, it never happened-that, surely was more terrifying then death†(34; Bk1, ch. 3).If the government is saying that something did or did not happen they are altering history, which is lying to its people. Winston states,† Nothing exists except an endless present in which the party is always right†(155; Bk. 2, ch. 5). Due to the lies about the past the people think that their society is good because they don’t know the actual situation before Big Brother. Thus creating a false reality of what happened in the past. This shows that they have lied to their citizens and thus there society was a failure. In Animal Farm it was portrayed that all animals were created equal, when is actuality that is not true.Towards the beginning of the book before the takeover all the animals were equal in theory. As soon as the takeover took place, Napoleon and the rest of the pigs established themselves as the leaders thus making them higher up in the society. Benjamin reads what was on the wall,† All animals are created equal, but some animals are more equal than others†(143; ch. 10). This is different from the original idea in that every animal was equal no matter what because of the fact that they didn’t like the humans and didn’t want to be like them.This is where they lied in regards to the changing of the slogan and gave the ir society the mark of death. Just like the other instances the lack of capability of the government not to lie to its people is very slim. This fact leads to the failure of the society as a whole. In 1984 and Animal Farm the government lied to their people which eventually led to their societies failure. If an individual does not have the ability to say something that is factual without the fear of being shot that is a functional society.It is not when the person is told what to think, how to think it, and when to think it. Also if the government lies to its people about its past then there is no way for anyone to try to make a better future. This leads to the failure of the society as a whole. Finally when the government from Animal Farm lied about the equality of its people they doomed there societies identity forever. Everyone wants to be equal and if you take that away then what are u left with. Fact is if the government lies to their people such as in Animal Farm and 1984 thei r society is doomed to failure.

Ascariasis and Trichuriasis

————————————————- OBJECTIVES I. Objectives Within our 3 weeks clinical exposure at San Pedro Hospital at St. Luke’s Ward, we, the proponents of San Pedro College, BSN 3E, group3, subgroup2, will be able to present a comprehensive nursing case analysis regarding the case of our patient who have a Bronchopneumonia in which we can gain more knowledge to understand further our clients condition. In order to achieve the general objective stipulated above, this case analysis aims to: a.Present a rationale discussing the rotation, patient’s medical status, statistics which include the international, national and local statistics about the case and its nursing implications; b. assess patient in a cephalocaudal manner; c. obtain factual information regarding patient’s data base including the biographical data, clinical data, family health history, past health hi story, and history of present illness; d. construct a family genogram to trace the family history that will show us the health status, hereditary diseases, and the present condition of the client and his family ; e. ite at least 2 definitions of the diagnosis from the book and 1 from the internet source f. discuss the specific medical management including drug studies and diagnostics according to the condition of the patient; g. explain the related nursing theory that can apply to the situation of the patient; h. formulate one (1) nursing care plan applicable to the patient; i. compose a comprehensive discharged plan following METHOD. j. list all sources and references used in the making of this case study. ————————————————- ————————————————- INTRODUCTIONII. Intr oduction Oxygenation concept covers the study of different concepts on oxygenation and the nursing care for clients having problems and alterations from the normal process of oxygenation. Oxygenation is the dynamic interaction of gases in the body for the purpose of delivering adequate oxygen essential for cellular. The systems involved in this concept are the respiratory, cardiovascular and hematologic systems. This concept functions to support the different clients in the clinical setting by providing nursing care, providing health teachings, and helping them restore their body’s normal functioning.The group has been clinically exposed in St. Luke’s Ward were we encountered our client N. A , a 6 year old female who was admitted due to fever under the service of Dr. R. Mata on Room 443-2 who has Bronchopneumonia. The group then decided to make him our main subject in our case analysis for the reason that his condition was perfectly related to our oxygenation rotation and also its affected organ is the respiratory system while its affected organ is the lungs.We have chosen her as our patient for our case analysis because of our desire to gain more knowledge and understanding of the disease and the condition in which our patient is experiencing. Bronchopneumonia is an acute inflammation of the lungs and bronchioles, characterized by chills, fever, high pulse and respiratory rates, bronchial breathing, cough with purulent bloody sputum, sever chest pain, and abdominal distension.The disease is usually a result of the spread of infection from the upper to the lower respiratory tract, most common caused by the bacterium Mycoplasma pneumoniae, Staphylococcus pyogenes, or Streptococcus pneumoniae( Mosby,2010) For international statistics according to world health organization children under 5 years of age they have 613,600 cases with 2,044 number of childhood deaths in the year 2004 ( Retrieved from http://whqlibdoc. who. int/publications/2006/92806404 89_eng. df ) While for its national statistics according to Department of health for the age 5-9 years old they got 244 cases of pneumonia for girls and 287 cases for boys with a total of 531 cases for both sexes While for the local statistics according to Department of Health they have 174 cases for every 100000 children with the incidence rate of 253. 16 for the year 2007 only in Davao city. This case study would contribute a lot on the quality of nursing education, practice, and research. First, to nursing education, this case study would keep the group equipped with knowledge, skills, and attitudes on ow to manage future patients with Bronchopneumonia it then nourishes those lessons learned in the scope of our concepts. To the nursing practice, this case study would help those who are practicing their professions as nurses, student nurses and other people who are medically inclined by being able to improve their nursing management and intervention to patients who had Bronchopneu monia. In application, those learned from our lectures can be related more to an actual state thus having a higher understanding, as to improve our skills and thinking.This case is facilitative to nursing research, because all data that we have gathered will help us in understanding the disease process of the patient. This would also help the group identifying the primary needs and health problems that would arise; thus it will help researchers that will encounter the same problem in the future. The group hopes that in the future technology can give the patients a more reliable treatment in an affordable and easy way for the patient. ————————————————- DEFINITION OF DIAGNOSIS BRONCHOPNEUMONIA/ CAP MR Bronchoneumonia can be a primary illness (often called community acquired pneumonia or CAP) or can develop as a complication of another respiratory infection or underlying illn ess. The causes of pneumonia in children vary depending on the season and the child’s age and health status. Pneumonia most likely develops when the body is unable to defend against infectious agents, which could be viruses, bacteria, mycoplasma, fungi, chemicals, foreign substances, or various other organisms or materials. It is also that not all inflammation of the lung is infection in origin. It could be caused by aspiration of foreign substances.Source: Bowden, V. , Greenberg, C. (2008). Pediatric Nursing Procedures Second Edition. Lippincott Williams & Wilkins. * Community acquired pneumonia (CAP) – Occurs either in the community setting or within 48 hours of hospitalization. The agents that most frequently cause CAP requiring hospitalization are Streptococcus pneumoniae, H. influenza, Legionella, Pseudomonas aeroginosa and other gram negative rods Source: Bare, B. , Cheever, K. , Hinkle, J. , Smeltzer, S. (2009). Brunner and Suddarth's Textbook of Medical Surgica l Nursing 12th edition. Lippincott Williams ; Wilkins Moderate risk community acquired pneumonia manifests vital signs that are not within normal range, having symptoms of tachypnea, tachycardia and fever. It can have x-ray findings of multi-lobar involvement, progression of lesion to 50% within 24 hours, abscess and pleural effusion. It is suspected to be prone for aspiration. It can be associated with extrapulmonary findings of sepsis and unstable comorbid condition. Source: http://www. slideshare. net/crisbertc/pneumonia-4775641 ASCARIS LUMBRICOIDES * Ascaris Lumbricoides is also known as the giant intestinal roundworm. Adult roundworms live in the small intestines.Fertilized and unfertilized eggs develop in the soil into embryonated stage which is the infective stage. Soil is commonly contaminated in areas where there are no sanitary toilet facilities or where human feces is used as fertilizer in vegetable garderns. Source: Maglaya,A .. [et. al]. (2009). Argonauta Corporation. M arikina City, Philippines * Ascaris Lumbricoides is a genus of nematode worms; large parasitic intestinal roundworms found throughout temperate and tropic regions. Source: Mosby’s Pocket Dictionary. (2010). Elsevier. Singapore. * Ascaris lumbricoides, giant roundworm, is the most common parasitic worm in humans.According to some estimates 25 % of humans are infected with the disease, ascariasis. Ascariasis occurs worldwide, mostly in tropical and subtropical countries. It has highest prevalence in areas of poor sanitation and where human feces are used as fertilizer. Source:http://www. parasitesinhumans. org/ascaris-lumbricoides-giant-roundworm. html TRICHURIS TRICHIURA * Trichuris Trichiura is also known as the whipworm because the anterior end is highly attenuated and the posterior end is thicker and more fleshy. It is another common intestinal worm and is usually found together with ascaris. Source: Maglaya,A .. et. al]. (2009). Argonauta Corporation. Marikina City, Philip pines * Trichuris Trichiura is a species of whipworms, commonly found in warm,moist regions of the world. Ingestion of whipworm eggs results in infection in humans; the parasits live mainly in cecum or large intestine. Source: Mosby’s Pocket Dictionary. (2010). Elsevier. Singapore. * Trichuris trichiura is a nematode (roundworm) also called the human whipworm. The third most common round worm of humans. Occurs worldwide, with infections more frequent in areas with tropical weather and poor sanitation practices, and among children.It is estimated that 800 million people are infected worldwide. Trichuriasis  (infection with Trichuris trichiura) occurs in the southern United States. Source: http://www. medterms. com/script/main/art. asp? articlekey=12961 ————————————————- PHYSICAL ASSESSMENT A. Physical Assessment Date and time of assessment: September 21,2012, 9 a. m. * GENERAL SURVEY N. A. , six years old, female has a mesomorphic body structure and she weighs 15 kilograms. She is wearing a clean hospital gown. Her hair was black in color and is unkempt. She has a brown-complexion.Upon interview with the watcher, the patient is alert and oriented and in an appropriate mood. * VITAL SIGNS VITAL SIGNS| RESULT| NORMAL VALUES| Blood Pressure| 90/60mmHg| 87/48 – 117/64 mmHg| Temperature| 35. 8  °C| 35. 6 – 37. 5 C| Cardiac Rate| 110 bpm| 60 – 100 bpm| Pulse Rate| 102 bpm| 60 – 100 bpm| Respiratory Rate| 30 cpm| 20 – 25 cpm| I. SKIN, HAIR, NAILS The patient has a brown complexion and is generally uniform in color. The skin is dry, rough to touch and with fair skin turgor. The body’s temperature is uniform all throughout the body and is within the normal range (36-37  °C). no lesions, edema or ulcerations noted.Hair is black in color and in normal distribution. Texture is brittle. Infestations noted such as dandruff and lice. Body hair is variable in amount. The fingerplate has a convex curvature with an angle of 160 °. Nail beds are pinkish reflecting a good circulation. Epidermis surrounding the nail is intact. After performing the blanch test of capillary refill, there is a prompt return of usual color in 3 seconds. II. HEENT * HEAD The patient’s head is normocephalic. Facial features are symmetrical, palpebral fissures equal in size and symmetrical nasolabial folds. Muscle strength of jaw is normal. * EYESEyebrows are evenly distributed and symmetrically aligned. The skin is intact and movements are equal. Eyelashes are equally distributed and slightly curled outward. No lesions or discoloration noted on both eyes. Sclera is clear. The palpebral conjunctiva is smooth and pale. The pupils are black in color, equal in size of about 2mm in diameter, round and have a smooth border. The iris appears brown in color. * EARS The ears have the same color as that of facial skin, symmetrical and aligned with the outer canthus of the eye. It is mobile and not tender. However, the texture is dry. Normal voice tones are audible.No discharges noted. * NOSE External nose is uniform in color and no discharge noted. The nasal mucosa is pink in color. The nasal septum is intact and in midline. * MOUTH AND OROPHARYNX The lips are pinkish and moist and has symmetrical contour. The tongue is in midline without any lesions present. There were twelve upper teeth and ten lower teeth present. Two upper molars have been extracted and one lower molar has cavity. The gums are pink. The oral mucosa has a uniform pink color and moist. Hard and soft palate are pinkish in color. Gag reflex is present. III. NECK Neck muscles are equal in size.Head movements are coordinated and smooth with no discomforts. Trachea is centrally placed in midline of neck and spaces are equal on both sides. The thyroid gland is not visible upon inspection. IV. BACK The skin is uniform in color. No les ions, areas of tenderness, redness or abrasions noted. V. ANTERIOR THORAX AND LUNGS Upon inspection, difficulty of breathing/ tachypnea was observed. The patient used accessory muscles such as shoulders and the abdominal muscles to assist in breathing. Crackles where heard on both lung fields upon auscultation. Pleural friction rub is also present. Chest skin turgor is good. VI. POSTERIOR THORAX AND LUNGSThe anteroposterior diameter of the chest has a ratio of 1:2. The skin is intact, temperature is uniform, chest wall is intact and no masses or tenderness noted. Upon palpation,tactile fremitus is increased when patient is asked to say, â€Å"1,2,3†. VII. CARDIOVASCULAR SYSTEM No pulsations, lifts, or heaves noted on aortic, pulmonic, triscupid and apical areas noted upon inspection. Normal cardiac sounds heard upon auscultation (S1 and S2). Peripheral pulses have full pulsations with symmetrical pulse volumes. Peripheral leg veins are symmetric in size. Limbs are not tender. Capillary refill time of 3 seconds was recorded.VIII. ABDOMEN The skin color is uniform. No lesions, masses or tenderness noted. Audible bowel sounds of 5-10 sounds per minute. IX. EXTREMITIES No nodules or deformities observed on shoulders, arms and elbows. Forearms can be flexed, extended, or put to supine and prone position. Contractures, redness, bone enlargements, nodules, atrophy and tremors were not observed. Fingerplates are of convex curvature and nail beds are pinkish. No pain or tenderness, deformities on hip joints and thigh. A visible scar on right calf is present and measures 2. 5 inches. Lesions, edema, inflammation and deformities are absent.NEUROLOGIC ASSESSMENT * Mental Status * Language Client can talk and is able to express himself by speech and gestures. She can articulate clearly. * Orientation The client was able to recognize other persons such as her relatives, nurses on duty and his physician. She is oriented of the time of the day and was aware of where sh e is at the present moment. * Memory The client was able to recall the meal she had for breakfast. She also remembered some of the hospital personnel that were assigned to her. * Attention span and calculation The patient has a short attention span as she is easily distracted by her surroundings.Her ability to calculate was done through giving simple arithmetic questions (addition and multiplication). Her answers are correct. CRANIAL NERVES Cranial Nerve| Type| Function| Assessment| Olfactory| Sensory| smell| We covered the client’s eyes and she was able to identify the smell of milk and peanuts. | Optic| Sensory| Vision and Visual Fields| The patient does not know how to read but sees clearly the prints on the paper given to her. | Oculomotor| Motor| EOM, movement of sphincter of pupil, movement of ciliary muscle of the lens| The patient was able to see through the 6 extraocular movements.The pupil size was 2mm at both left and right eye, was briskly reactive to light and ac commodation. It constricts and dilate in response to light. | Trochlear| Motor| EOM, specifically moves eyeball downward ; laterally | The patient was able to move her eyes from left to right and right to left without moving her neck. | Trigeminal| Sensory ; Motor| Sensation of cornea, skin of face and nasal mucosa| When the patient clenched her jaw, her temporal and masseter muscles felt equally strong. Jaw movement was normal. The patient blinked as the wisp of cotton touched the lateral sclera of the eye.She also felt the cotton as it touched her left and right cheeks. | Abducens| Motor| EOM, specifically, moves eyeballs laterally| The patient as able to rotate her eyes in a circular manner from top to left to bottom and to right and back to top as instructed. | Facial| Sensory ; Motor| Facial expression, taste (anterior two-thirds of the tongue)| The patient has symmetrical facial features when instructed to smile, frown, close eyes and puff cheeks. | Vestibulocochlear| Sensory| Hearing ; balance| The patient was able to hear the student nurses properly during normal voice conversation. Glossopharyngeal| Sensory ; Motor| Swallowing ability, tongue movement| Gag reflex was present by touching the posterior part of the using using a tongue depressor. | Vagus| Sensory ; Motor| Swallowing, vocal sord movement| The student nurses asked the patient to open her mouth widely and observed during inspection that the palate and uvula rises in the midline as patient says â€Å"ahh†. | Accessory| Motor| Head movement, shrugging of shoulders| The patient was able to move his head to her left and right against the hand as a resistance and has equal strength.She was able to move her head up and down freely. Her sternocleidomastoid and trapezius muscles were equal in size upon inspection and palpation. | Hypoglossal| Motor| Protrusion of tongue from side to side, up ; down| The patient was able to move her tongue to his left and right, up and down and was able to pr otrude her tongue. | ————————————————- ————————————————- ————————————————- HISTORY ————————————————- TAKING PERSONAL DATA Name: N. A Age: 6 years old Gender: femaleHome Address: Davao City Birth date: January 16, 2006 Nationality: Filipino Religion: Christian Civil Status: Child CLINICAL DATA Hospital Institution: San Pedro Hospital Ward: St. Luke’s Ward Room and Bed no: 443-2 Date Admitted: August 19, 2012 Time Admitted: 1:00am How admitted: Per ambulatory Chief Complaint: Fever Attending Physician: Dr. Richard Mata Family Health Histo ry In the maternal side of our client, both of the grandparents of N. A died, her grandmother M. B. died at the age of 62 because of myoma, she had a history of asthma, while its grandfather died for unknown reason also had asthma.The couple was blessed with 7 children including the mother of our client Amy and Aladin who also has a history of asthma, their siblings Archie and Arnold both have asthma and fond of smoking and drinking alcoholic beverages. While Ariel died at the age of 35 and also had asthma. For the paternal side, the grandmother of our client had a history of asthma while its grandfather has TB and fond of smoking. They were blessed with 5 children including the father of our client R. A who also likes to drink and smoke, his sister M.A died at the age of 7 because it drowned on the beach, while its brother aldrin had a history of asthma and was also a smoker and drinker, their brother Renante died at the age of 26 due to stab wound and was a smoker and drinker befo re. Our client N. A was used to be asthmatic as well as its brother J. A ————————————————- ————————————————- GENOGRAM Past Health History According to the mother of our client when she was pregnant for our client she always go to their barangay for prenatal check up, she said she gave birth of N.A at the age of 16 in full term at their house here in Davao City with the help of her trusted midwife in a normal spontaneous vaginal delivery, she said that she first noticed a blood in her underpants and started to feel pain following a ruptured bag of water after an hour, she said that she labored not less than 8 hours. The mother of our client also shared that during the childhood days of her daughter it had chicken pox, tonsillitis, sore eyes and asthma when she it was 2 years old, her mother also stated that her daughter N.A completed her immunizations such as BCG, DPT, OPV, Measles, HIV, and Hepa B. Per interview to the mother, she stresses that her daughter had her first hospitalization when she was just months and was admitted at Regional now called SPMC due to diarrhea and vomiting, but then after 5 days of admission, the Doctor had given the family a list of medications but forget their names , the mother shared that the moment they got home after 5 days the mother of our client noticed a stainless earrings in her daughter’s feces, When our client N.A was 3 or 4 years of age she was then again admitted at San Pedro Hospital under the service of Dr. Lubo in due to swelling of its right lower extremity , according to the parents their daughter underwent a minor surgery just enough to remove the bacteria or some kind of microorganism present. They describe the leg of their daughter with a redness surrounding its puss unfortunately th ey cannot remember what’s the case was but they shared that during that admission N.A was also diagnosed with Pneumonia with the used of chest X-ray, its third hospitalization was the present. Our client has no allergy to any kind of food nor medications, according to N. A’s mother her daughter stop breastfeeding when she was 2 while according to its father his daughter was a picky eater in terms of vegetables, he said she could only count the number of vegetables her daughter ate, according to our client she prefer pork, fish or fruits than vegetables.Per interview to our client she said she eliminates once a day, and urinates at least 2-3 times per day and sometimes urinates when asleep. N. A also shared to us that she usually sleeps after watching Lorenzo’s Time and wakes up at 6 am to prepare for school, she was a kinder student in one of the project hope here in Davao City, according to her she had lots of friends in school and they usually play, hide and s eek, Dampa, Chinese Garter and the like. Present Health History Our client N.A had an on and off fever for 4 days, her mother gives their trusted paracetamol neo-kiddielets yet they decided to admit their daughter last September 19, 2012 at 1:00 am under the service of Dr. Mata on room 443-2, he was then ordered to have CBC,Urinalysis , CXR and fecalysis. The result of CXR indicates that our client has bronchopneumonia and was also positive of ascaris and trichuris, he was given medications and one of them is antiox to get rid of the parasite inside our patient. ————————————————-MANAGEMENT Radiologic Findings Procedure| Rationale| Impression| Nursing Responsibilities| X-ray of the chest and abdomen| Test done to visualize the internal structures using the x-ray| Hazy infiltrates seen in the inner lung zones. Heart and great vessels are not unusual. Diaphragm and costophren ic sulci are intact. The rest of the included structures are unremarkable. Bronchopneumonia| * Let the patient wear the prescribed hospital gown * Remove other garments and other accessories * Transport patient to the X-ray room. Provide safety and privacy| Hematology: Complete Blood Count provides a fairly complete evaluation of all formed elements in blood. It can supply a great deal of the information necessary to diagnose a hematologic disorder, help to identify disease states not directly related to hematopoietic system, and help to evaluate the stages and prognosis of certain diseases. It helps to detect the abnormality of the component of the blood that shows underlying diseases in the patient condition before performing a surgery or operation.Date| Component| Rationale| Results| Clinical Significance| Interventions| SEPTEMBER19,2012| Hemoglobinmale 140-180g/dlfemale 120-160g/dl| Hemoglobin is a protein in red blood cells that carries oxygen. A blood test can tell how much he moglobin you have in your blood and determine the ectent of Anemia. | 110g/dl| Elevated Values:Polcythemia, DehydrationDecreased Values:Many cancers, Hodgkin’s disease, Lymphosarcoma, Anemia, and malutrition and as a side effect of chemotherapy| Pretest Patient Care for CBC, Hemogram: * -Explain to the patient or watcher the procedure, process and purpose of the test to be done. Inform them that the test requires a blood sample and slight discomfort may be felt when skin is punctured. * * – Avoid stress if possible because altered physiologic status influences and changes normal hemogram values. * – Select hemogram components ordered at regular intervals. These should be drawn consistently at the same time of day for reasons of accurate comparison; natural body rhythms cause fluctuations in laboratory values at certain times of the day-Dehydration or overhydration can dramatically alter.The presence of either of these states should be communicated to the laborat ory. -Fasting is not necessary. However, fat-laden meals may alter some tests results as a result of lipidemia. Intra:-Inform the patient that venous blood is to be collected-Venipuncture should be performed in an aseptic technique as well as the collection of sample. Posttest Patient Aftercare for Hemogram, CBC:-Apply manual pressure and dressings to the puncture site on removal of the needle. -Monitor the puncture site for inflammations or hematoma formation.Maintain pressure dressings on the site if necessary. Notify physician of unusual problems with bleeding. -Resume normal activities and diet. -Bruising at the puncture site is common. Signs of inflammation are unusual and should be reported if the inflamed area | | Erythrocytesmale 4. 5-5. 0female 4. 0-5. 0x10^12/L| The number of red blood cells per cubic millimeter of blood. erythrocyte indices,n. pr the standard values of red blood cell numbers, morphologic characteristics, and behavior in comprehensive hematologic laborator y testing. | 4. 3 x10^12/L| Decrease in value means hemorrhage, hemolysis anemias, cancer, over dehydrationIncrease in value meas polycythemia, dehydration, living at high altitude| | | MCHMean Corpuscular Hemoglobin27 – 33picograms/cell| is the average mass of hemoglobin per red blood cell in a sample of blood. It is reported as part of a standard complete blood count. | 26. 0picograms/cell| MCH less than lower limit of normal: hypochromic anemia MCH within normal range: normochromic anemia MCH greater than upper limit normal: hyperchromic anemia| | | MCVMean Corpuscular Volume80 – 96femtoliter| is a measure of the average red blood ell volume that is reported as part of a standard complete blood count. | 80Femtoliter| MCV less than lower limit of normal: microcytic anemia MCV within normal range: normocytic anemia MCV greater than upper limit of normal: macrocytic anemia| | | MCHCMean corpuscular hemoglobin concentration32 to 36 grams/deciliter| The MCHC is a measure of the concentration of hemoglobin within a red blood cell. This measurement is useful in evaluating the clinical response of an anemic patient to therapy. | 32. 6grams/deciliter| Decreased: microcytic anemiaIncreased: hereditary spherocytosis| | | Leukocytes(5. -10. 0x10^9/L)| A useful guide in determining the severity of disease process. It will identify certain persons with increase susceptibility to infection through measuring total amount of WBC in the body| 3. 7 x10^9/L| Elevated Values:. An increase in the number of circulating leukocytes is rarely due to an increase in all five types of leukocytes. When this occurs, it is most often due to dehydration and hemoconcentration. In some diseases, such as measles, pertussis and sepsis, the increase in white blood cells is so dramatic that the picture resembles leukemia.Decreased Values:Aplastic anemia, bone marrow depression, pernicious anemia, some infectious or parasitic disease| | | Neutrophils(0. 55-0. 65%)| Neutrophils are p roduced in huge numbers in response to infection, trauma, infarction (cell death due to lack of blood supply), emotional distress or other stimuli. They cruise around the blood stream waiting to be called to a site where damage is happening. Once there, they kill the invading bacteria and other noxious substances, usually dying in the process themselves. The method they use to kill invaders is called phagocytosis which involves engulfing and digesting the â€Å"enemy† cell. 0. 48 %| Elevated Values:Elevated in bacterial infection, Hodgkin’s disease, Decreased Values:Decreased in Leukemia and malnutrition and as a side effect of hemotherapy, Infection, drug reaction, autoimmune neutropenia, maternal antibody production, aplastic anemia. | | | Lymphocytes(0. 25-0. 40%)| Lymphocytes consist of the B cells and T cells. The B cells make antibodies and the T cells regulate the immune response. Lymphocytes secrete products (lymphokines) that modulate the functional activities of many other types of cells and are often present at sites of chronicinflammation. 0. 41 %| Elevated Values:Elevated in lymphocytic leukemia, Hodgkin’s disease, multiple myeloma, viral infections, and chronic infections, cytomegalovirus infection, petussis, brucellosis, tuberculosis, syphilis. Decreased Values:Decreased in malnutrition, cancer, and other leukemias and as asdie effect of chemotherapy. Human Immunodeficiency Virus Infection, Miliary Tuberculosis, Renal failure, Terminal Cancer| | | Monocytes(0. 02-0. 06%)| Monocyte is a type of white blood cell, part of the human body's immune system.Monocytes have several roles in the immune system and this includes: (1) replenish resident macrophages and dendritic cells under normal states, and (2) in response to inflammation signals| 0. 09 %(High)| Elevated Values:Elevated in Acute infection, monocytic leukemia and cancer. , chronic myeloid leukemia, acute monocytic leukemia, myelomonocytic leukemia, lupus erythematosus, p olyarteritisnodosa, rheumatoid arthritis| | | Eosinophils(0. 01-0. 05%)| Eosinophils contain toxic substances that kill foreign cells in the blood. An absolute eosinophil count is a blood test that measures the number of white blood cells called eosinophils.Eosinophils become active when you have certain allergic diseases, infections, and other medical conditions. | 0. 01%| Elevated Values:Elevated in cancer of bone, ovary, testes and brain. Skin diseases, trichonosis, Scarlet fever, Chronicmyelogenous leukemia, Myeloproliferative diseases. Decreased Values:Allergies, Pyogenic infection, Shock, Postsurgical response| | | Basophils(0. 000-0. 005%)| A type of white blood cell in the circulation which is characterized by its ability to uptake certain dyes when stained for examination under the microscope (basophils appear blue).Basophils play a part in the allergic response as they have IgE on their surface, and release chemical mediators causing allergic symptoms when the IgE binds to its specific allergen. | 0. 01 %| Elevated Values: Elevated in leukemia and healing stage of infecion. Hypersensitivity reactions, ulcerative colitis, chronic hemolytic anemia, Hodgkin’s disease, myxedema, chronic myelogenous leukemia, polycythemia veraDecreased Values:Hyperthyroidism, Pregnancy, Stress, Cushing syndrome| | | Hematocrit(0. 40-0. 48%)| Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells.This measurement depends on the number of red blood cells and the size of red blood cells. | 0. 34%(Low)| a danger sign of an increased risk of dengue shock syndrome. Polycythemia vera (PV) is associated with elevated hematocrit. PV is a myeloproliferative disorder in which the bone marrow produces excessive numbers of red cells, and reflects excessive numbers of RBC precursors in the bone marrow, as well as some abnormal forms. This condition is called erythroid hyperplasia. Lowered hematocrit can imply signi ficant hemorrhage. | | | Thrombocyte(150-300 x10^9/L)| Thrombocytes are important for normal blood clotting.If there are not enough thrombocytes, the risk of uncontrolled or prolonged bleeding increases. When there are too many thrombocytes in the blood, abnormal blood clot formation, a serious and life-threatening condition, can occur. Looking at the numbers, size, and health of thrombocytes is a part of a Complete Blood Count (CBC) test. | 27610^9/L| Increased values:Increased in malignancy, myeloproliferative disease, rheumatoid arthritis, and post operatively; about 50% of pt. with unexpected increase of platelet count will be found to have a malignancy.Decreased values : thrombocytopenic purpura, acute leukemia, aplastic anemia, and during cancer chemotherapy. | | Urinalysis: The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and urinary tract and kidney disorde rs. Date| Component| Definition &Normal range| Rationale| Result| Interpretation &Significance| Nursing Responsibilities| SEPTEMBER19,2012| Color| Mainly a result of the presence of the pigment urochrome, (produced through endogenous metabolic processes).N: Light yellow to amber| The urinalysis is a routine screening test which is usually done as a part of a physical examination, during preoperative testing, and upon hospital admission. The results of UA are used to diagnose, treat, and provide follow-up for a variety of conditions, such as infections of the kidneys and urinary tract and also in the diagnosis of diseases unrelated to the urinary system. | Light Yellow| A red or red-brown (abnormal) color could be from a food dye, eating fresh beets, a drug, or the presence of either hemoglobin or myoglobin.If the sample contained| PRE-PROCEDURE * Explain to the patient the purpose of the routine urinalysis and the need for a urine sample to be obtained. †¢ No fasting is require d prior to the test. | | Appearance/Turbidity| Generally refers to the clarity of the urine sample. N: Clear to slightly hazy| | Clear| Turbidity or cloudiness may be caused by excessive cellular material or protein in the urine or may develop from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator.Clearing of the specimen after addition of a small amount of acid indicates that precipitation of salts is the probable cause of turbidity. | INTRA-PROCEDURE * Testing the first morning urine specimen, when the urine is concentrated, is preferred. * A minimum sample of 15 mL of urine is required. * A clean-catch midstream technique to obtain the urine sample is recommended to prevent contamination of the specimen. * Give instructions to the client on how to catch urine. * Instruct patients to avoid touching the inside of the specimen container and lid. For the portions of the urinalysis which involve use of dipstick testing, a reagent strip is dipped into the urine specimen. After a period of time specified by the manufacturer of the dipstick, the color of the reagent pad is compared with a color chart provided by the manufacturer. * Gloves are worn throughout the procedure. POST-PROCEDURE * Label the urine specimen and transport it to the laboratory immediately. The urine needs to be examined within 2 hours. * If urine is collected via an indwelling urinary catheter, a syringe and needle is used. Remove the needle prior to transferring the urine to the specimen cup to avoid damage to any microscopic sediment which may be present. Report abnormal findings to the primary care provider. | | Specific Gravity| Indication of the kidney’s ability to reabsorb water and chemicals from the glomerular filtrate. N: 1. 010 – 1. 025| | 1. 005| If it is below 1. 003 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generalized renal impairment or nephrogeni c diabetes insipidus. In end-stage renal disease.Having over 1. 035 is either contaminated, contains very high levels of glucose, or the patient may have recently received high density radiopaque dyes intravenously for radiographic studies or low molecular weight dextran solutions| | | Glucose| Glucose is virtually absent from the urine. Less than 0. 1% of glucose normally filtered by the glomerulus appears in urine (< 100 mg/24 hr). N: 0-100mg/dL| | (-)Negative| Presence or Excess sugar in urine means, Glycosuria, generally means diabetes mellitus. | | | Protein| Urine normally contains only a scant amount of rotein, which derives from both the blood and the urinary tract itself. N: 0-30mg/dL| | (-)negative| Trace positive results (which represent a slightly hazy appearance in urine) are equivalent to 10 mg/100 ml or about 150 mg/24 hours (the upper limit of normal). 1+ corresponds to about 200-500 mg/24 hours, a 2+ to 0. 5-1. 5 gm/24 hours, a 3+ to 2-5 gm/24 hours, and a 4+ repres ents 7 gm/24 hours or greater. More than 150 mg/day is defined as proteinuria. Proteinuria > 3. 5 gm/24 hours is severe and known as nephrotic syndrome. | | WBC| Usually, the WBC's are granulocytes. White cells from the vagina, especially in the presence of vaginal and cervical infections, or the external urethral meatus in men and women may contaminate the urine. N: 0- 17 / UL| | 3| Pyuria occurs if the presence of leukocytes is abnormal or increased which may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. | | | RBC| finding of red blood cells in the urine (hematuria) is considered abnormalN:0- 11 / UL| | 1| RBC in urine is slightly higher than normal.Significantly high RBC number in urine may point to acute tubular necrosis, benign familial hematuria, calculi, hemophilia, hemorrhagic cystitis, pyelonephritis, renal trauma, renal tuberculosis, renal tumor, or UTI. | | | Epithelial Cells| Renal tubular epithelial cells, usually lar ger than granulocytes, contain a large round or oval nucleus and normally slough into the urine in small numbersN: 0- 17/UL| | 5| If the number sloughed is increased nephrotic syndrome and in conditions leading to tubular degeneration,| | | Cast| Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct (distal nephron).The proximal convoluted tubule (PCT) and loop of Henle are not locations for cast formation. Hyaline casts are composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells. N: 0-1/ UL| | 0| Presence of protein cast formation is often caused by low flow rate, high salt concentration, and low pH, all of which favor protein denaturation and precipitation. blood cell cast are indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or severe tubular damage.White blood cell casts are most typical for acute pyelonephritis, but they may also be present with glomerulonephritis. Their presence indicates i nflammation of the kidney, because such casts will not form except in the kidney. | | | Bacteria| Bacteria are common in urine specimens because of the abundant normal microbial flora of the vagina or external urethral meatus and because of their ability to rapidly multiply in urine standing at room temperature. Therefore, microbial organisms found in all but the most scrupulously collected urines should be interpreted in view of clinical symptoms.N: 0- 278/ UL| | 3| More than 278/ UL of one organism reflects significant bacteriuria. Multiple organisms reflect contamination. | | STOOL ANALYSIS: It is the evaluation of the characteristics of the clean catch fecal specimen. The physical characteristics as well as the contents of the feces are evaluated for the presence of gastrointestinal abnormalities such as infections. SEPTEMBER19,2012| Color| Brown| | | Consistency| Coarse| Unusualities in the stool consistencies may indicate GI abnormalities such as malabsorption and infection.Co arseness or excessive dryness may result from poor hydration status or presence of parasites in the GIT. | | Parasite ova| Trichuris TrichiuraAscaris Lumbricoides| Presence of ova in the stool indicates positive parasitic infection in the gastrointestinal system| | Pus Cells| 2-4/hpp| Pus production is an indicator of GIT infection as a defense mechanism activated by the immune system| Medical Order Order| Rationale| 9/19/121:15am > Please admit under the service of Dr. R.Mata (PC) >Secure consent for admission & mgt >Diagnostics:-CBC c PC-U/A-CXR – APC>Therapeutics:Cefuroxime (100_ 500mg IVTT q 8 hours (ANST)Paracetamol 250mg/5ml, 3ml q 4 hours RTCSalbutamol neb, I neb q 6 hrs>DAT c SAP>IVF : D5IMB 500cc to run @ 55 cc/hr >encourage pt to increase oral fluid intake>TSB for fever>VS q 4 hrs & record pls>I & O q shift, record>will inform AP of this admission>refer PRN, thanks! >Cont. meds & ebulization>fill up official CXR result 8am>Fecalysis3pm(+)LBM X 3>Erceflora I vial BI D >Increase rate of IV to 60cc/hr9. 20pm(+) trushing(+) ascarisStool exam>stat mebendazole (antiox) 50g/ml ,10ml on single dose9/20/128am>cont. meds(-) fever3pm Afebrile >cont. meds>refer for unusualities9/21/128am(-) fever>cont. meds| -To be able to accommodate the patient’s needs for optimum health care and to be able to refer any unusualities immediately and to continue patient monitoring. – This consent legalizes the acceptance and trust of the client to the health practitioner. With this laboratory test, the patient’s condition will be determined. – These medicines have different action thereby treating the client’s symptoms manifested by the client from her present condition-Maintain healthy diet within normal range and since the patient can tolerate any food he desires that is nutritious. Strict aspiration precaution since the patient was a child should be carefull and prevent aspiration-Is a hypertonic solution , for slow administration ess ential to prevent overload (100ml/hr)- To prevent dehydration-To help relieve fever- To obtain baseline data of VS and monitor condition of patient until stable. These measures excessive loss or retention of water in the body. – These medicines have different action thereby treating the client’s symptoms manifested by the client from her present condition. – to analyze the condition of a person's digestive tract in general -To Promote normalization of intestinal flora. -Besides of becoming asource of nutrition it also help replace the water loss by patient due to LBM-An antihelmintics , treatment of parasites present in the patient- These medicines have different action thereby treating the client’s symptoms manifested by the client from her present condition.These medicines have different action thereby treating the client’s symptoms manifested by the client from her present condition. – For the physician to be informed immediately, facilit ating attendance of the unusuality at hand- These medicines have different action thereby treating the client’s symptoms manifested by the client from her present condition. | ————————————————- ————————————————- ————————————————-DRUG STUDY GENERIC NAME: Acetaminophen BRAND NAME:   paracetamol CLASSIFICATION: Antipyretics, Non opiod analgesic MODE OF ACTION: Inhibits the synthesis of prostaglandins that may serve as mediators of pain ; fever, primarily in the CNS. Has no significant anti-inflammatory properties or GI toxicity. THERAPEUTIC EFFECTS: Analgesia. Antipyresis. ORDERED DOSE: 250 mg/ 5 ml, 3ml q 4 (RTC) DATE ORDERED: 9-19-12 SUGGESTED D OSE: 10-15 mg/kg/dose q 4-6 hr as needed INDICATIONS: Mild pain. Fever.CONTRAINDICATIONS: Contraindicated in: Previous hypersensitivity; Products containing alcohol, aspartame, saccharin, sugar, tartrazine (FDC yellow dye #5) should be avoided in patients who have hypersensitivity or intolerance to these compounds. DRUG INTERACTIONS:Drug-Drug: Chronic high dose acetaminophen may increase risk of bleeding with warfarin. SIDE EFFECTS: GI: hepatic failure, hepatotoxicity (overdose) GU: renal failure (high doses/ chronic use Derm: rash, urticaria NURSING RESPONSIBILITIES: 1. ) Monitor blood studies. 2. ) Monitor liver function studies. 3. Monitor renal function studies. 4. ) Check I ; O ratio. (decrease output may indicate renal failure) 5. ) Assess for fever ; pain. 6. ) Assess allergic reaction. 7. ) Assess hepatotoxicity: dark urine, clay colored stools, jaundice, itching, abdominal pain. 8. ) Assess for chronic poisoning : rapid, weak pulse; dyspnea : cold extremities; 9. ) Give dru g with food or milk to decrease gastric symptoms 10. )Tell patient that urine may become dark brown as a result of phenacetin (metabolite of acetaminophen) GENERIC NAME: Cefuroxime BRAND NAME:   Ceftin, ZinacefCLASSIFICATION: Anti-infectives MODE OF ACTION: Bind to bacterial cell wall membrane, causing cell death. ORDERED DOSE: 500 g IVTT q 8 ANST (-) DATE ORDERED: 9-19-12 SUGGESTED DOSE: INDICATIONS: Treatment of following infections caused by susceptible organisms: respiratory tract infections, bone ; joint infections, urinary tract infections, meningitis, gynecologic infections, lyme disease, perioperative prophylaxis CONTRAINDICATIONS: Contraindicated in: Hypersensitivity to cephalosporins, Serious hypersensitivity to penicillins. DRUG INTERACTIONS:Drug-Drug: Probenecid decrease excretion ; increase blood levels. Concurrent use of aminoglycosides or loop diuretics may increase risk of nephrotoxicity. SIDE EFFECTS: CNS: seizures, GI: pseudomembranous colitis, diarrhea, cramps, nausea, vomiting DERM: rashes, urticaria Local: pain at IM site, phlebitis at IV site Misc: anaphylaxis, serum sickness, superinfection NURSING RESPONSIBILITIES: 1) Observe ten rights of administering medication 2) Assess for infection. 3) Observe patients for signs of anaphylaxis. (rash, pruritis, laryngeal edema, etc) 4) Monitor Vital signs specially Temperature ) Advise patient to report signs of superinfection ; allergy. 6) Instruct patient to notify health care professional if fever ; diarrhea develop especially if stool contains blood, pus, or mucus, 7) Advise patient not to treat diarrhea without consulting health care professional. 8) Monitor patient for life threatening adverse effects, including anaphylaxis, steve-johnson 9) Monitor kidney and liver function test results and intake and output 10) Instruct patient to take drug with food GENERIC NAME: Bacillus Clausii BRAND NAME:   Erceflora CLASSIFICATION: antidiarrhealsMODE OF ACTION: Contributes to the recovery of the i ntestinal microbial flora altered during the course of microbial disorders of diverse origin. It produces various vitamins, particularly group B vitamins this contributing to correction of vitamin disorders caused by antibiotics ; chemotherapeutic agents. Promotes normalization of intestinal flora. ORDERED DOSE: q 1 vial BID DATE ORDERED: 9-19-12 SUGGESTED DOSE: Children 2-11 years 1-2 vials of 2  billion/5 mL susp INDICATIONS: for acute diarrhea with duration of ;14 days due to infection drugs or poisons. Chronic or persistent diarrhea with duration of ;14 days.CONTRAINDICATIONS: Contraindicated in: not for use in immunocompromised patients (cancer patients on chemotherapy, patients taking immunosuppressant medications) SIDE EFFECTS: No known side effect or adverse effect. NURSING RESPONSIBILITIES: 1. ) Observe ten rights of administering medication 2. ) Shake Drug well before administration 3. ) Monitor patient for any unusual effects from drug. 4. ) Administer drug within 30 mi nutes after opening container. 5. ) Dilute drug with sweetened milk. , orange, tea. 6. ) Administer drug orally. GENERIC NAME: mebendazole BRAND NAME: VermoxCLASSIFICATION: antihelmintics ORDERED DOSE: 50g/ml DATE ORDERED: 9/19/12 INDICATIONS: Treatment of whipworm, pinworm, roundworm, hookworm, infections. CONTRAINDICATIONS: Contraindicated in: Hypersensitivity. DRUG INTERACTIONS: Drug-Drug: Use with potassium-sparing diuretics or ACE inhibitors or angiotensin ll receptor antagonists may lead to hyperkalemia. Anticholinergics may increase GI mucosal lesions in patients taking wax-matrix potassium chloride preparations. SIDE EFFECTS: CNS: seizures, dizziness, headache GI: abdominal pain, diarrhea, increased liver enzymes. Nausea, vomiting Neuro: numbnessMisc: fever NURSING RESPONSIBILITIES: 1. Observe ten rights of administering medication 2. Administer with food. 3. Disinfect toilet facilities after patient use. 4. Arrange daily for daily laundry of bed linens, towels, undergarment s 5. Assess for temperature, bowel sound ; output 6. Culture for ova ; parasites 7. Monitor hematologic and hepatic studies 8. Advise patient to wash hands before and after eating 9. Teach patient to maintain strict hygiene to prevent reinfection 10. Advise patient that dietary restrictions, fasting, and laxatives aren’t necessary GENERIC NAME: albuterolBRAND NAME:   salbutamol CLASSIFICATION: Bronchodilators MODE OF ACTION: Binds to beta-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase ; increased levels of cyclic-3’, 5’ ORDERED DOSE: 1 neb q 6 DATE ORDERED: 9-19-12 INDICATIONS: Used as bronchodilator to control ; prevent reversible airway obstruction caused by asthma or COPD. CONTRAINDICATIONS: Contraindicated in: Hypersensitivity to adrenergic amines; Hypersensitivity to fluorocarbons. DRUG INTERACTIONS: Drug-Drug: Concurrent use with other adrenergic agents will have increase adrenergic side effects.Use with MAO inhibit ors may lead to hypertensive crisis. SIDE EFFECTS: CNS: nervousness, restlessness, tremor, headache, insomnia CV: chest pain, palpitations, angina, arrhythmias, hypertension GI: nausea, vomiting Neuro: tremor NURSING RESPONSIBILITIES: 1. ) Observe ten rights of administering medication 2. ) Inform patient that albuterol may cause an unusual or bad taste. 3. ) Advise to rinse mouth with water after each inhalation to minimize dry mouth 4. ) Instruct to notify health care professional if no response to the usual dose. 5. ) Chest tapping after each nebulization. . ) Position patient on high back rest position 7. ) Advise to consult physician before taking OTC med, natural/ herbal products, or alcohol with this therapy. 8. ) do not give a food immediately it can cause vomiting 9. ) Monitor serum electrolyte levels 10. )Monitor for hypersensitivity reactions and paradoxical bronchospasm. ————————————†”———- ————————————————- ————————————————- RELATED NURSING THEORY ————————————————- Florence NightingaleShe stated in her nursing notes that nursing â€Å"is an act of utilizing the environment of the patient to assist him in his recovery† , that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.This theory was applicable to our client because of that the disease of our client is related to its environment. Our client has brochopneumonia which can be afflicted with our environment plus a weak immune system which initiates the disease process. Our client was also positive to Ascaris Lumbricoides and Trichuris Trichiura in which we could really tell that they are having a problem in terms of taking care of themselves like paying attention to their personal hygiene and the like in their community,. Environment is such a big factor to use and all other disease process that is done to our client. Envir onment provides the things that we that may do good or bad to us.Environment is also not always defined by the things around you but also the things that we can provide such as silent and soothing environment which is initially the best type of prevention for us. Know regarding to our client the factors that initiate healing status of our client is that the concern for sanitation it shows that having been infected with ascaris and trichuris is affected by unsanitary environment and other factors such as place of living, lifestyle etc. We must provide a sanitary environment to help boost immune system and ease the way for recovery and also we must initiate a supportive atmosphere to enhance the capabilities of client to rely to boost self confidence in having good prognosis and having a healthy and not anxious set of mind set. ———————————————— ———â€⠀Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- NURSING CARE PLAN ————————————————- DISCHARGE ————————————————- PLAN Medication * Explain to the patient and significant others the reason why the drugs were prescribed by the doctor.  ® Providing sufficient information about treatment aids patient and family education as well as gains cooperation. * Encourage patient and family not to miss a dose during the whole duration of therapy. It is important to take your medicine exactly as you are told.  ® Medications taken full course give full therapeutic effects to the patient.In addition, this would also prevent the development of antibiotic resistant microorganisms. * Instruct the family to immediately stop medic ations if adverse reactions occur and refer immediately to the physician.  ® This prevents the occurrence of further progression of life-threatening adverse reactions. * Advice patient’s significant others to ask before taking any food or herb supplements, vitamins, or medicine that he/she bought at the store.  ® Some of these may negatively interact with the drugs that are being taken. Exercise * Instruct the family to provide adequate rest and sleep.  ® This aids the patient’s recovery and helps him regain strength. Tell client to continue deep breathing exercises, also instruct family for the exercise needed.  ® This is to promote good blood circulation and relaxation. * Encourage ambulation and active range of motions.  ® It mobilizes and loosen secretions. Treatment * Encourage the patient to follow the doctor’s orders  ® It is important to take your medicine and follow instructions exactly as what they are told. * Instruct patient and family to follow-up check-up as indicated by the physician.  ® Follow up check-up can help in monitoring the progress, reassessment, and evaluation of patient’s condition. * Encourage the family to comply with the treatment regimen for the patient. This helps by improving the recovery rate of the patient. Hygiene * Encourage the patient and significant others to wash hands more often especially when after using the bathroom.  ® To deter spread of microorganisms which cause various illnesses. * Encourage bathing daily.  ®This is to prevent spread of microorganism and promote self esteem. * Instruct the patient to promote good oral hygiene especially after eating.  ® This lessens the occurrence of dental caries. * Encourage patient to incorporate in his habit the proper way of washing her hands and covering her mouth when coughing.  ® This prevents the spread of microorganisms and further contamination. Out-Patient Advise patient and family to go back to the hospital in a spec ific date for follow-up check-up after discharge.  ® This enables the physician to reassess and evaluate the health status of the patient. * Consult a doctor if there are any problems or any complications encountered.  ® This calls for immediate action or interventions which may prevent furthermore complications. Diet * Diet as tolerated as much as possible.  ® To meet the daily requirements of the body as well as to have an optimum nutritional diet. * Encourage patient to drink 8 glasses of fluids a day.  ® To improve hydration as well as to excrete wastes accordingly. * Encourage to ensure safe water sources or if necessary, boil water for drinking. This is to eliminate the risk of any bacterial or parasitic infection. * Encourage to avoid eating raw foods such as raw meat. If dealing with fresh vegetables, wash it thoroughly with water.  ®This is to avoid microorganisms which could be present that can cause illnesses * Encourage the family to provide nutritious foods su ch as fruits and vegetables.  ® Fruits and vegetables are rich in essential vitamins and nutrients, which aid in supplying the optimum nutrition for the patient. ————————————————- ————————————————- REFERENCE (s) Reference (s) : * Bare, B. , Cheever, K. , Hinkle, J. , Smeltzer, S. (2009).Brunner and Suddarth's Textbook of Medical Surgical Nursing 12th edition. Lippincott Williams ; Wilkins * Bowden, V. , Greenberg, C. (2008). Pediatric Nursing Procedures Second Edition. Lippincott Williams ; Wilkins. * Maglaya,A .. [et. al]. (2009). Argonauta Corporation. Marikina City, Philippines * Mosby’s Pocket Dictionary. (2010). Elsevier. Singapore. * http://www. slideshare. net/crisbertc/pneumonia-4775641 * http://www. parasitesinhumans. org/ascaris-lumbricoides-gi ant-roundworm. html * http://www. medterms. com/script/main/art. asp? articlekey=12961 * http://whqlibdoc. who. int/publications/2006/9280640489_eng. pdf * Department of Health * World Health Organization

Gammasonics Institute for Medical Research Pty Ltd

Gammasonic v Comrad[1] demonstrates the reluctance of the courts to interpret the Sale of Goods Act to include software downloads as a â€Å"good†, preferring to leave the matter up to statutory review. It primarily discusses whether a software package delivered by online download is effectively classed as â€Å"goods† for application of Sale of Goods Act[2] and outlines the progressive court decisions that have considered the question and have begun to recognize software attached to a medium, like a cd package as a â€Å"goods†. It also briefly addresses the applicability of statutory warranties of fitness for purpose and merchantable quality and supports that fitness for purpose and merchantable quality are implied by common law giving reference the test for implication in fact outlined in BP Refinery (Westernport) v Shire of Hastings (1977)[3] Background and overview The disputing parties are Gammasonics, a provider of services to radiologists in NSW, and Comrad, a business that provide software and information management systems to radiologists in Australia and New Zealand. The dispute concerns a contract between the parties for the delivery and installation of a software package via remote internet download called â€Å"Comrad RIS†; which was to manage workflow, patient registration and appointments, online referrals and processing of Medicare claims for Gammasonics. The software was downloaded onto Gammasonics’ server and Gammasonic were purportedly responsible for hardware configuration and the network infrastructure specified to run the software. Comrad delivered the software via internet download and certain areas of the software did not function as required. Gammasonics claimed to terminate the contract for breach of terms including â€Å"failure to deliver a functioning software package, failure to provide goods of a merchantable quality and/or for the delivery of a software package which was not fit for its intended purpose.† [4] Comrad in turn sought an award for damages due to the repudiation of the contract by Gammasonic. Trial Proceedings This case is an appeal from Local Court against orders made by Magistrate Quinn in favour of Comrad for the amount of $58,011.21. There Magistrate Quinn was not convinced the software supplied by Comrad was a â€Å"good† as defined in s5 of the Sale of Goods Act 1923[5] and â€Å"held the act did not apply†[6]. She also found Comrad failed in the delivery of certain components required for the software functioning; however it was stated that it was â€Å"Gammasonics' own acts or omissions and not any conduct for which it had contractual responsibility that rendered the system unworkable, such that Gammasonics’ purported termination was a repudiation of the contract thereby entitling Comrad to sue for damages.†[7] Material Issues The following are the key issues that arise from the judgement and contain the essential elements of the case which will be discussed in this case note. 1. Whether a software package delivered by online download is effectively classed as â€Å"goods† for application of Sale of Goods Act.[8] 2. Whether equivalent terms of fitness for purpose and merchantable quality are implied by common law. 3. Breach of essential terms The matter of whether a breach of contract is a question of mixed fact and law is also addressed in this case but it will not be extensively discussed within this case note. Whether a question of mixed fact and law arises was dealt with early in the case and Fullerton J was satisfied that the question of whether her Honour erred in holding that Comrad was not in breach of the contract, involved a question of mixed fact and law and as such leave to appeal ought be granted. Comrad also filed a notice for contention on two points one concerning the implication of terms into the contract equivalent to the statutory warranties of merchantable quality and fitness for purpose, the other on the question of breach. The Sale of Goods Act 1923 The definition of goods provided in the Sale of goods Act 1923 (NSW) s5(1) is Goods include all chattels personal other than things in action and money. The term includes emblements and things attached to or forming part of the land which are agreed to be severed before sale or under the contract of sale. It was submitted by Gammasonics that the software provided by Comrad was within the statutory definition of â€Å"goods† and they relied among other things on the implied condition as to quality or fitness in the act outlined in s19.[9] On appeal a request was made to consider whether there was a â€Å"Fresh Analysis of Authorities†[10] with a more modern approach to interpretation of the Act. Whether a software package delivered by online download is effectively classed as â€Å"goods† for application of Sale of Goods Act.[11] The case gives a thorough analysis and contains a comprehensive list of authorities that include case law and secondary sources which have reviewed this question. The key area of difference noted was that the software was delivered by download onto a server. This distinguished the case from that of others including Toby Constructions Products Pty Ltd v Computa Bar (Sales) Pty Ltd[12] where the software was held to be a ‘good’ because it comprised both software and hardware. Gammasonics relied on a passage from Advent Systems Ltd v Unisys Corp [13] as authority where an analogy was drawn to musical compositions and music on cds suggesting that once the software had been downloaded to the server it became a tangible thing. However the common thread is that software provided on a disc falls within the statutory definition of a ‘good’ while remote download via a license it appears currently does not. The case Fullerton J considered most analogous to the facts was St Albans City. [14] In this case the question of whether the transfer of the software, without the sale of the disk would give rise to a sale of â€Å"goods† under the Sale of Goods Act 1979 (UK) was considered by Sir Glidewell. There the disk was likened to an instruction manual however again the distinction is made between the delivery of the software via disk format and remote download a distinction that was also noted by Sir Glidewell. An Australian case that revisted the question was Re Amlink Technologies Pty Ltd and Australian Trade Commission[15] this case did not follow the reasoning offered in St Albans City[16] by Sir Glidewell and considered the proposition taken to the extreme would see goods being defined in areas that where never meant to be covered by the act. Secondary sources were further considered as Gammasonics highlighted what they supported to be a ‘growing trend’ in Australia to recognize software as a ‘good’[17] The recent Trade Practices Law Journal article by Svantesson discussed the stages of development citing Toby Constructions[18]as the first step taken in recognition of software sold together with hardware as a good. The article also highlighted the decision in Amlink Technologies[19] to recognize software attached to some physical medium and suggested the next logical step for the courts was to further recognize software not attached to a physical medium. A passage from a conference paper was also considered[20]where the distinction is made that where a customer purchases a digitized version of an encyclopedia it is a good however where it purchases access to the encyclopedia database it is a supply of a service. The facts of this case are most like that of the first scenario and the plaintiff submitted that the authorities support the conclusion that the software provided by Comrad is a ‘good’ under the act[21] It fell however to the principals of statutory interpretation in particular the everyday meaning of goods and possession. Comrad submitted that the ordinary meaning and any interpretative words referred to things that are tangible; therefore, â€Å"because lines of computer code are intangible the position contended for by Gammasonics was inconsistent†.[22] Fullerton noted that it was preferable to give protection to consumers purchasing software by digital download and noted that research suggests that this is an increasing form of delivery means but stressed the need for legislative reform[23] in the area not judicial intervention and found that the Sale of Goods Act did not apply. Whether equivalent terms of fitness for purpose and merchantable quality are implied by common law. The case also outlines that common law terms as to fitness for purpose and merchantable quality can be implied. This is in accordance with test for implication in fact [24] from BP Refinery (Westernport) v Shire of Hastings which is: 1) it must be reasonable and equitable; (2) it must be necessary to give business efficacy to the contract, so that no term will be implied if the contract is effective without it; (3) it must be so obvious that â€Å"it goes without saying†; (4) it must be capable of clear expression; (5) it must not contradict any express term of the contract†. Although the test was ultimately not considered. Breach of Essential Terms With regard to the breach of essential terms two main areas were readdressed. The interfacing with Medicare and network incompatibility. In both cases the documentary evidence was reviewed. While the plaintiff submitted that the findings of the Local Court were in error and that Comrad was responsible for both resolving the problems of interfacing with Medicare and for creating the interfacing problems. Comrad failed to provide sufficient evidence to support these claims and Fullerton J was not satisfied that Quinn J was in error therefore the appeal was dismissed. Effect on Current Law This case has been referred to in a recent journal article discussing when ‘software is a good’.[25] It has also been referenced in the recent edition of Australian Commercial Law[26] as the authority for the principal that software delivered online does not constitute a good, within the meaning of the Sale of Goods Act[27]. The case highlighted the need for legislative review in regard to the status of computer software and with the introduction of new legistlation The Australian Consumer Law (ACL) it has finally been decided that for the purposes of the ACL software is now specifically included within the definition of goods [28] affording consumers protection under s54 Guarantee as to acceptable quality[29] and s55 Guarantee as to fitness for any disclosed purpose.[30] It also shows the courts reluctance for judicial intervention on matters that may have wider applications in the interpretation of legislation and illustrates the progressive nature of the courts to effect change.

MOHG Essay Example | Topics and Well Written Essays - 1000 words - 1

MOHG - Essay Example bserved that the competition relating to the segment of hotel industry is likely to increase in future that ultimately depicts that Mandarin Oriental Hotel Group (MOHG) would face the difficulty new participants in the industry (Scribd Inc., 2012). By taking into concern this imperative aspect, MOHG effectively develops effective business strategies in the form of external plans. The group emphasises upon advancing its working people as well as enhancing teamwork as a structure of external strategy with the intention of dealing with the aforementioned problem (TMIUS, 2001). The suppliers’ bargaining power is expected to be moderate in recent day context as the reputed or renowned hotels do not desire to compromise their delivered services with quality (Scribd Inc., 2012). In this regard, MOHG execute the strategy of buying products in bulk quantity from its different suppliers that ultimately supports the group to lessen suppliers’ bargaining power (HKMA, n.d.). There have been numerous operators or hotels in the global hospitality industry, which eventually augments huge competition amid the existing market players (Alpen Capital, 2011). In a similar concern, MOHG adopts as well as implements effective business strategies in order to accomplish significant competitive position over its chief business market contenders. The group has been noted to frequently develop its various products or services and most significantly it organises dynamic promotional campaigns of its different services in order to remain competitive in the hospitality industry (HKMA, n.d.). The customers possess broad assortment of options that are readily accessible to them due to the introduction of internet as a form of online channels. This particular aspect not only supported the customers to take appropriate choices for their destinations but also enabled them to review as well as compare hotels along with their services by a greater extent. Thus, it can be stated that

Essentials Skills for Business Projects Essay Example | Topics and Well Written Essays - 1250 words

Essentials Skills for Business Projects - Essay Example This overview affects all types of business projects excluding projects in distance education. Several project managers underutilize their skills about project management (Crawford, 2000). This paper evaluates the key skills required for the successful completion of business projects and reviews the common reasons for project failure. By acclimatizing with better project management skills, the modern-day project managers can improve their skills in executing and accomplishing the goals and objectives of business projects as defined by the senior management.   For any business project to take off and cruise through all the obstacles and challenges, proper project planning is a key factor and skill in completing the imminent objective successfully. Project managers have to develop clear prospective outcomes as well as execute desirable tasks needed to accomplish the objectives. The most significant initial step is identifying the scope of the project (Lavell & Martinelli, 2008). By doing this, project managers can estimate the size, boundaries, and purpose of the project in such a way that they â€Å"create a box† that facilitates the real components needed â€Å"in the box† while distinguishing them from the ones â€Å"out of the box.† Consequently, skillful project managers must ensure that they deliberate on every executable task in order to unearth ideas that can propel the business project to the final stage (Remington & Pollack, 2007). After brainstorming, the tasks should be arranged in the most consistent or der to get the business project running to its completion. However, new tasks might come up in the course of the business project, and skilled project managers should not hesitate to add them appropriately without changing the scope of the project (Fairholm, 2003). With the above measures, the budget of the business project needs accurate estimation.

Nazi Deception and the Demoralization and Dehumanization of Eliezer Essay

Nazi Deception and the Demoralization and Dehumanization of Eliezer and his Fellow Prisoners - Essay Example When Elie Wiesel first reached the concentration camp in Auschwitz a sign caught his attention that said "Arbeit macht frei" which translated into â€Å"work makes you free† (Wiesel 40). There was a great deal of irony within that phrase. Like in all other concentration camps, in Auschwitz, Jews were persecuted and forced to work for the Nazi forces. The working conditions of these concentration camps were inhumane, and the death of these workers due to starvation and exhaustion were a common sight. Hard work in these concentration camps never paid off in terms of freedom. In fact, Jews in these camps were even deprived of basic needs such as food water and in some cases even shelter. The Nazis used the sign as a mode of deception, and they were well aware of the fact that providing freedom to Jews was never an option. The sign was put up to provide a fake incentive to the Jews to work harder for them. The concentration camp located in Auschwitz was well famous for the amount of work that was forced upon the Jews and the torture that was brought upon them as well. Different works were assigned to the prisoners at the concentration camp. Some were forced to dig huge craters and few of the prisoners Elie saw carrying bags of sands â€Å"Prisoners were at work. ... According to the author the idea of deception was to confuse the prisoners into ensuring that then they would not be able to trust anyone. In the book the Nazis provided the prisoners with false hope regarding their freedom. They realized that the Nazis were not planning to keep their promise about ensuring their freedom prisoner’s trust in other individuals was also shattered. This led to the prisoners losing value in relationships with friends and family and anyone close to them. Eventually, these prisoners would fall into a state where they would act in a completely non-human manner. Once in a non-human state these prisoners started attacking everyone and anyone that they felt was a threat to them or they felt possessed something that might be of value to the attacker â€Å"Dozens of inmates were there to receive us, sticks in hand, striking anywhere, anyone without reason† (Wiesel 35). In short Nazi’s deception had such a powerful affect on the prisoners that it primarily dehumanized their fundamental nature and forced them to act as animals. Night and has been compared with the likes of The Diary of a Young Girl by Anne Frank, and If This is a Man by Primo Levi (Franklin). There has been a great deal of controversy regarding the content. A number of scholars believe that Wiesel’s book night may not be completely a memoir and that parts of the books may be fiction (Franklin). Nevertheless Night has been one of the best books to have been written recounting the holocaust. The book gave an account of how concentration camps did not just inflict physical torment on the Jews there but were also subjected to mental torture as well. Nazis gave prisoners within the concentration camps a false hope of freedom and gave them an incentive to work harder at these