Malignant Hyperthermia free essay sample

Clinical signs are; Increased end tidal CO2 production which is an early sign, tachycardia, tachypnea, trunk or total body rigidity, masseter (jaw) muscle rigidity after succinylcholine which occurs commonly in children, marked temperature elevation (maybe a late sign), respiratory and metabolic acidosis, myoglobinuria(MHAUS, 2011). If left untreated the patient will experience cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, and possibly death (slideshare, 2010) Nursing Assessment Nurses taking care of surgical patients must be knowledgeable regarding MH so they can identify clinical signs and symptoms early on, its emergent treatment, and be able to respond promptly and appropriately. Preoperative assessment by nurses are crucial in identifying the patient, who could be at high risk for Malignant Hyperthermia, so MH triggering agents can be avoided during anesthesia. Example of questions to ask to help screen for MH susceptibility are (AORN 2012): 1. Has anyone ever told you that you had a â€Å"bad† reaction to anesthesia? 2. We will write a custom essay sample on Malignant Hyperthermia or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Has anyone ever told you that you or your family member had a problem with anesthesia? . Have you or a family member experienced a high fever while under anesthesia? 4. Has anyone ever told you or a family member they had a difficult time opening your jaw during general anesthetic? 5. Has anyone in your family died unexpectedly in the operating room? 6. Have you or anyone in your family experienced sunstroke or heat stroke resulting in hospitalization? 7. Have you ever noticed dark â€Å"cola-colored† urine after a general anesthetic or after experiencing a heat-related illness? Treating MH Dantrolene IV is the only drug available in the market to treat Malignant Hyperthermia. It is difficult to mix and is time consuming to reconstitute. It comes in yellowish colored powder that when fully mix with non-bacteriostatic sterile water, the color stays the same. The new brand Dantrium IV (dantrolene sodium for injection) mixes in just 20 seconds (MHAUS, 2011). However, this is not what we have stocked in our cart. According to MHAUS (2011), dantrolene suppresses the exaggerated rise in muscle cell calcium that seems to trigger MH by binding to the calcium channel site in muscle that is responsible both for calcium release and, likely, calcium entry into the cell. Dantrolene may cause significant muscle weakness in patients with preexisting muscle disease and should be used with extreme caution in those patients. When used with calcium channel blockers (verapamil or diltiazem), dantrolene may produce life-threatening hyperkalemia and myocardial depression. Once a patient has been successfully treated for 36 hours with intravenous dantrolene, he/she may be switched to oral dantrolene until the CK or Creatine Kinase level is trending down and there is no further evidence of acidosis or hypermetabolism and temperature spikes. A recommended 36 vials be stocked. Treating Malignant Hyperthermia crisis is a complex nature, and it involves several staff members. The first thing to do in the event of suspected MH crisis is to recruit extra staff. The following steps are outline by role (MHAUS, 2011): The surgeon should stop or complete the procedure as soon as possible. The anesthesia provider stops inhalation agents; stops warming blanket; increase minute ventilation; inserts esophageal temp probe; inserts NG tube for lavage as needed; administers dantrolene IV; inserts an arterial line; draws blood for chemistry, ck, coagulation, ABG. If peaked T waves on ECG, administers calcium then glucose and insulin. If T waves are not peaked and arrhythmia present, injects bicarbonate. The circulating nurse brings in MH cart; mixes dantrolene based on 2. 5 mg/kg with 60 ml of non-bacteriostatic sterile water, repeat dose until the signs are controlled. The circulating nurse should document the event. A second nurse assist in mixing dantrolene and hands syringe to anesthesia provider. A third nurse brings in emergency crash cart; places urinary catheter; assist in drawing blood or with other task. A fourth nurse brings in plastic bags with ice and cold IV fluids; places ice bags on exposed parts like groin, axilla, and neck (without compromising sterility); iced saline lavage of any open body cavities such as the stomach, bladder, or rectum. Cold I. V. fluids are administered using 0. 9% sodium chloride, but Lactated Ringer’s is avoided so that acidosis is not worsened (Martin, 2009). Stop cooling measures when temperature falls to 38 °C (MHAUS, 2011). A laminated copy of MHAUS dantrolene dosage chart is located on top of MH cart to minimize precious time wasted in calculating dosage per kilogram. As soon as patient is stabilized, transfer patient to ICU or call transfer center for an emergent transfer to UH Case SICU or ED. Knowing your Role All staff involved in the MH crisis response should conduct a debriefing meeting as early as possible. Points to consider including (AORN, 2012): 8. Was the MH cart adequately stocked and immediately available? 9. Were enough staff members available to manage the crisis effectively? 10. When staff members responded, were they familiar with task expected in MH crisis? 11. Was MHAUS appropriately notified? 12. Do staff members have other ideas about planning care for a future MH crisis? 3. Has a root-cause analysis been done (MH is considered a sentinel event)? Staff Competency By using the mannequin as our patient, and mixing the expired dantrolene from MHAUS, perioperative staff did fairly well during the MH mock drill simulation by following thru with the expected roles. MH drill should be held at least quarterly to help perioperative st aff practice early recognition of MH crisis and how to act accordingly. MH drill also improve OR (operating room) team coordination and provides opportunities to serve in each of the four roles mentioned (Martin, 2009). Prevention Early detection of clinical signs and symptoms of MH, knowing your role and a prompt response to this emergent crisis can save your patient’s life. MH crisis prevention is the key and the best treatment you can provide to your patient. Knowledge about MH is a must for nurses taking care of a patient before, during and after operative care. Armed with this knowledge, you can make a difference in your patient’s lives.

The Man Behind Jay Gatsby essays

The Man Behind Jay Gatsby essays In the novel "The Great Gatsby" by F. Scott Fitzgerald, no one really seemed to know the man known as Jay Gatsby. When he was rich and powerful, he was a man everyone "wanted to be well acquainted with." But when he died, life went on without him. It seemed as if nobody cared that he was the man behind the extravagant parties and all the good times. He was dead and nobody mourned or gave any signs of sympathy. This shows the difference of opinions of the great Jay Gatsby throughout the story. He was an icon of not only every man's image of the American Dream, but he was also a part of Americanism and the American Experience. He was seen as the richest and luckiest man during his time. Unlike any of the other characters in the novel, Jay Gatsby does not change during the course of the story. He as a person may not have changed, but the way that people perceived him certainly became different. When he was alive and well, he was the perfect example of the American Dream. "He took out a pile of shirts and began throwing them one by one before us, shirts of sheer linen and thick silk and fine flannel which lost their folds as they fell and covered the table in many-colored disarray (Fitzgerald 97). This illustrates how he had more money than he knew what to do with. He could afford to have oversized parties every weekend and live the lavish style that he did. Jay Gatsby was the person to know when it came to West Egg. In the beginning, he was only known as Jay Gatz. He was a poor boy who had joined the army. He only had his charm to get him by. With that, he met Daisy. She was a very rich and sheltered girl from a wealthy family. They were in love from the beginning. Unfortunately, Daisy believed overall that security was of more importance than of love. From that moment on, Jay Gatz wanted one thing; to get rich so he could gain Daisy's approval and also to show her that a poor boy can become wealthy. This obsession ate up and de...

PSYCHOLOGY OF RELIGION Essay Example | Topics and Well Written Essays - 1000 words - 1

PSYCHOLOGY OF RELIGION - Essay Example Erikson thinks that Gandhi is helpful in addressing this type of violence. In the 1960s period, social scientists questioned the relevance of studying the effects and consequences of religion on crime. They were of the view that religion, for instance, in the United States of America was not a key source of values, beliefs and other forms of operative norms. Religion forms a part of an individual’s identity. It has many attributes, one of which is religion. It is a representation of the unique culture, religious orientation, experience and gender among other things. Erikson considers identity as a belief in sameness and a progression in the sense of a shared world. His theory of pseudo speciation can be applied to the formation of religious groups. Group conflicts arise from the evolvement of human beings for certain reasons into a complex interaction based on adversarial relationships (Erikson 3). Erikson places importance on man as a social being who must always belong to social groups. It is with this notion that he proposed the existence of massive ritual defenses of communities. Erikson explained the concept of religion in terms of s psychological phenomenon. He explained the religion in Martin Luther’s age in terms of demons, Freudian unconscious and superstitions. He had contempt for the true God. He stated that the belief in demons allowed a persistent removal of an individual’s unconscious thoughts and preconscious impulses involving malice and variance. Therefore, religion is a creation of the unconscious part of human beings. Erikson’s theory explains the formation of religious groups. The grouping instinct arises when there are conditions that discriminate against religious communities in terms of politics and economy. This promotes conflicts along ideological insight especially when the threat perception increases and

Project Managment - Team work Evaluation Assignment - 1

Project Managment - Team work Evaluation - Assignment Example The group members came up with a substantial project process model that covered every sector of the project. Responsibilities were shared among members of the group to ease management and accomplish the goal of the project. Each stage was critically reviewed and parts that had problems were discussed by all members until an amicable solution was found. This model is important because it facilitates proper communication among different departments in the project (Kivipelto & Yliruka, 2012, p. 3). In addition, individuals are able to work with the allocated budget as resources are not wasted. It also helps to solve problems that are encountered as the project goes on so the project does not come to a standstill. This means that the project is likely to be completed in the stipulated time frame. Team members are motivated to work towards accomplishing the goal of the project since there are clear guidelines to be followed. The model provides a good system for conflict mangers thus the project is not swayed in the wrong direction. It is therefore very important to evaluate a team process model before starting the main

Effectively Managing A Work Life Balance Social Work Essay

Effectively Managing A Work Life Balance Social Work Essay Work-life balance is defined here as an individuals ability to meet their work and family commitments, as well as other non-work responsibilities and activities. Work life balance, in addition to the relations between work and family functions, also involves other roles in other areas of life. In this study, due to its more extensive associations, the concept of work -life balance is preferred. Work-life balance has been defined differently by different scholars. In order to broaden our perspectives, some definitions will be presented. Greenhaus (2002) defined work -life balance as satisfaction and good functioning at work and at home with a minimum of role conflict. Felstead et al. (2002) defines work-life balance as the relationship between the institutional and cultural times and spaces of work and non-work in societies where income is predominantly generated and distributed through labor markets. Aycan et al. (2007) confined the subject only with work and family and put forward the concept of life balance with a more whole perspective. Scholars defined life balance as fulfilling the demands satisfactorily in the three basic areas of life; namely, work, family and private. Work demands work hours, work intensity and proportion of working hours spent in work. Additional work hours subtract from home time, while high work intensity or work pressure may result in fatigue, anxiety or other adverse physiological consequences that affect the quality of home and family life( White et al.,2003). Family demands include such subjects as the roles of the individuals (e.g. Father, mother, etc.,) family responsibilities (e.g childcare, house chores, etc) looking after the old members, children. Besides this, there are some other demands in work life balance than family and work live relaxation, vacation, sports and personal development programmes. Work -life balance is not the allocation of time equally among work, family and personal demands. In literature, it is also emphasized that work-life balance is subjective phenomenon that changes from person to person. In this regard, work-life balance should be regarded as allocating the available resources like time, thought and labor wisely among the elements of life. While some adopt the philosophy of working to live and sees work as the objective, others consider living to work and situated work into the centre of life. DETERMINANTS OF WORK-LIFE BALANCE Many things in life are the determinants of work life balance. The subjects in the literature that are related the most with work life balance are grouped here. INDIVIDUAL: An individual is the most important determinant of work -life balance. two American cardiologists Rosenman and Friedman determined two different types of personality depending on heart disorders and individual behaviours: type A and type B. Type A expresses someone who is more active, more work oriented, more passionate and competitive, while Type B is calm, patient, balanced and right minded. It can be argued that since type A is more work oriented, there will be a negative reflection of it to work -life balance. Yet work holism, which is considered as an obsessive behavior, is another thing that destroys work-life balance. When work holism connotes over addiction to work, being at work for a very long time, overworking and busy with work at times out of work. Since life is not only about work, workaholics suffer from alienation, family problems and some health problems. Porter(1996) states that alcoholics, workaholics neglect their families, friends, relations and other social responsibilities. FAMILY: The demands that one experience in family life and that have effects on life balance can be given as the demand of workload and time, role expectations in family and support to be given to the spouse. It is also included in the literature that such variances as marriage, child rising, caring of the elderly at home have effect on work-life balance since they demand more family responsibilities. Those who have to look after a child or the elderly might sometimes have to risk their career by shortening their working hours, which becomes a source of stress for them. On the other hand, those without children or any elderly to look after at home experience less work-life imbalance. WORK AND ORGANISATION: Work environment is more effective in work-life imbalance than the family environment. The job and the institution one works in both demands on his time, efforts and mental capacity. Among the efforts to increase organizational efficiency, one of the subjects managers focus on is to raise the organizational efficiency, one of the subjects managers focus on is to raise the organizational loyalty of the staff. SOCIAL ENVIRONMENT: Another determinant of work-life balance is social environment. Especially in countries that stand out with their culturally collectivist characteristics, an individual also has responsibilities towards certain social groups he belongs. CONSEQUENCES OF WORK-LIFE IMBALANCE The stress based conflict occurs when one of the roles of the individual at work or in the family causes stress on the individual and this stress affects the other roles of the individual. The behavior stress occurs when the behavior at work and out of work are dissonant and conflicting. PERSONAL IMPLICATIONS According to Lowe (2005), work life imbalance affects the overall well-being of the individual causing such problems as dissatisfaction from life, prolonged sadness, using drugs or alcohol. FAMILY IMPLICATIONS: Organization expects from individual to allocate more time for their work while at the same time the family want him to perform his responsibilities too. Those who cant sustain work-life balance are bound to experience many problems in their families such as lower family satisfaction, decreased involvement in family roles etc. ORGANIZATIONALIMPLICATIONS: Those whose demands of the family and ones social interest are not met duly naturally prefer sacrificing his working hours, and carry out their personal needs. ORGANIZATIONAL PERSPECTIVE In order to decrease the negative consequences of work- family conflict on working individuals, family friendly organizational culture and human resources applications have recently been in agenda of executive. The components of the organizational strategy are flexible working hours , child care and elderly care scheme, home working ,job sharing. Supportive programmes for the family life of employees in an organization contribute to providing work -life balance. Thanks to these programmes, the employees will be encouraged, their attendance will be supported and their efficiency will increase. Flexible working hours is one of the methods used to maintain work-life balance. For example employees with flexi-time will have to fulfill certain amount of time weekly. Other thing which can be done is to allow employees to work at home away from traditional work environment. CONCLUSION: If one has managed to allocate the required time for every aspect of life duly and not to reflect the problems in one part of life to another it means that he has been able to achieve work-family balance. Life as a whole is composed of many other aspects along with work. Those who have achieved a balance among these aspects are sure to achieve the life balance, which does away with any imbalance.

Welfare: A Government Program in the US

In the United States, the word â€Å"welfare† is familiar to everyone. People usually consider welfare as government programs that distribute public assistance to the poor and low income people. However, some people, who are able to work, take advantage of or depend too much on welfare, and they consider welfare as their main source of income. To stop their dependence on welfare, the government should put those who are on welfare into the labor area and keep them there. Besides, the government should change their way of thinking about welfare and make recipients realize the goal of work and self-sufficiency. In order to accomplish this change, the government should replace the existing welfare by education and training programs. Some welfare recipients depend too much and take advantage of welfare. The sponsors of immigrants must be responsible for taking care of their family. However, they refuse to take their responsibility, and they consider that welfare must help them. For example, one sponsor in Orange County, California placed her parents on welfare even though she owned a $450,000 home and easily could afford to provide for their well-being. However, she notified the welfare agency that her elderly parents either would have to start paying rent or move out (Smith 31). Besides, welfare pays substantially more than recipients could earn from entry-level job (Tanner et al. 22). That is the reason why welfare recipients do not likely to look for job. As a result, if people can earn the same income by either working or not working, most people will choose not to work. In contrast, other people such as elders, retarded or disabled individuals, and single parent deserve to receive government assistance; however, they do not get as much as they need because the government provides welfare to both deserving and undeserving people. This will create an unbalancing gap between people. Those who really need welfare can not get enough; meanwhile, others receive more than what they need. Therefore, the government should provide welfare to deserving people who really need assistance and jobs to those who are able to work. In the article â€Å"Welfare Pays Better, So Why Work? † of USA Today Magazine, the authors state â€Å"Nearly everyone agrees that a major goal should be to encourage recipients to leave the welfare rolls and enter the workforce† (Tanner et al. 22). In order to encourage recipients to enter the workforce, the government should limit welfare because welfare is a source of income which recipients do not have to work to earn, so why do they have to work? Besides, welfare recipients must realize that welfare only helps them in short period of time. After that they have to be on their own because there is no one else can help them forever. If there is less welfare, working becomes the only source of income which they can depend on. Indeed, limiting welfare is parallel with seeking job. Once welfare is limited, labor force is the only place where they can get help. In order to encourage recipients to work, the government should create employment programs which assist recipients to look for job, to train and to gain skills. Although the employment programs might cost the nation more money in short term, they will be worth it in the long term. First, the government should persuade private employers to create more job opportunities for welfare recipients, and also welfare recipients should be required to participate in education and training programs. Besides, more employment services and job search assistance should be establish to help welfare recipients to have an easier time finding jobs. In addition, welfare money should be used to subsidize for education and training programs because these programs can provide skills and train them in order to meet the new demands of the labor market and meet the employer's specific needs. Furthermore, unemployment offices would no longer distinguish between those who were recently laid off and those who have been on welfare. Each person would be evaluated on the basis of what services she or he needs in order to obtain employment. Hence, everyone all has same opportunity to enter the workforce. Instead of improving the welfare programs, the government should look at them as an opportunity to create a more comprehensive employment programs that would replace the old welfare and public assistance programs. For this to occur, the government should create education and training programs to provide skills and train people in order to ensure all those who want to work are able to do so. Besides, more employment services should be established to assist people to look for job easier, and private employment creates more jobs to encourage people to work. Also, equal opportunity should be applied to everyone. As a result, all these programs should be shared a single goal: to enable people to work.

Assessment Base Reading Instruciton Case Study Essay

Table of Contents Introduction Description of the Student Background Information PART 1: Administration of Assessments DIBELS: A Universal Assessment Battery Description and Purpose of the Assessment Setting for the Assessment Description of the Assessment Administration Process Results of the Assessment Analysis of the Assessment Results Running Records Description and Purpose of the Assessment The running record allows you to record the child’s reading behavior as he or she reads from the book. The purpose of a running record is a tool used to determine word recognition reading fluency reading strategies, self- corrections, and comprehension. It is an individually conducted formative assessment which is ongoing and curriculum based. It provides a graphic  representation of a student’s oral reading, identifying patterns of effective and ineffective strategy use. This method was developed by Marie Clay, the originator of Reading Recovery. Running records helps document reading progress over time. Help teachers decide what students need to learn and matches students to appropriate books. We want to capture all the behaviors to help interpret what the child was probably doing. Everything the child says and does tells us something: when the reading is correct, what his hands and eyes were doing, the comments he made and when he repeated a line of text. Setting f or the Assessment Library setting, after school. This was the only time available. Description of the Assessment Administration Process Select a book that is the child’s reading level. Explain to the child that he or she will read out loud as you observe and record his or her reading behavior. Sit next to the child so that you can see the text and the child’s finger and eye movements as he or she reads the text. Use running record form. As the child reads, mark each word on the running record form by using the symbols on the chart that follows. Place a check mark above each word that is read correctly. If the child reads incorrectly, record above the word what the child reads. If the child is reading too fast for you to record the running record, ask him or her to pause until you catch up. Intervene as little as possible while the child is reading. If the child is stuck and unable to continue, wait 5 to10 seconds and tell him or her the word. If the child seems confused, indicate the point of confusion and say, â€Å"Try again.† Results of the Assessment Student read 156 words at 98% accuracy. She had 3 errors and 2 self corrects. She missed boredom, I told her the word. She changed plan for idea, setting, characters, and beginning. She had trouble with middle and end. She did know the main idea but could not list supporting details. I would move this student to a higher level text. This text was easy for the student. Analysis of the Assessment Results Student read 156 words at 98% accuracy. She had 3 errors and 2 self corrects. She missed boredom, I told her the word. She changed plan for idea, setting, characters, and beginning. She had trouble with middle and end. She did know the main idea but could not list supporting details. This student needs practice in retelling story in sequence. She had issues with middle and end. I think she was going for a fluency score and read too fast. She had problems orally retelling middle and end. This level is an appropriate level for this student. I will use the results to plan for this student. Teaching purposes for running records. To find a book level appropriate for a child. Check a child after a series of lessons. Evaluate whether a lift in text level is appropriate. Observe particular difficulties in particular children in order to modify instructional emphasis. Evaluate in order to place a child in an appropriate instructional group, class or school. Add to a record which is monitoring an individual’s progress over time. Reading Inventory Description and Purpose of the Assessment Setting for the Assessment Description of the Assessment Administration Process Results of the Assessment Analysis of the Assessment Results Additional Diagnostic Assessment: Learner Choice Description and Purpose of the Assessment Setting for the Assessment Description of the Assessment Administration Process Results of the Assessment Analysis of the Assessment Results Overall Analysis of Assessment Results PART 2: Recommendations for Interventions and Instruction Identifying Student Needs Recommendations for Interventions and Instruction Recommendations for Further Assessment References Appendices Appendix A: DIBELS Scoring Documents Appendix B: Running Records Scoring Documents Appendix C: Reading Inventory Documents Appendix D: Additional Assessment Documents