Love and Hate Research Paper Example | Topics and Well Written Essays - 1250 words

Love and Hate - Research Paper Example At long last an end is given about the paper. Theory Statement: In this exposition, a connection among ‘Love’ and ‘Hate’ is stressed. An enlightening critique is given in the kindness of the presence of connection among Love and Hate. Accounts of ‘The Storm’ by Kate Chopin, ‘Eveline’ by James Joyce, ‘Araby’ by James Joyce and ‘The Cask of Amontillado’ by Edgar Allan Poe are additionally talked about as references to demonstrate the presence of connection among Love and Hate. There are various convictions about ‘Love and hate’. Individuals consider these two passionate languages as per the appearances of their own personalities. Along these lines, in this position it very well may be said that the individual implications of Love and Hate may vary from individual to individual. In like manner, the connection between these two extraordinary feelings may fluctuate as per the conditions. It has been seen that there is a connection among ‘Love and Hate’, despite the fact that they appear to be in opposition to one another. It has been seen that practically all the Love stories have huge number of harmonies and they very clone. To demonstrate this, there are numerous things which are should have been mulled over. Numerous journalists and artists have composed heaps of lumps about ‘Love and Hate’. Spot light should be put on concentrates of those scholars and artists. Exacting implications of ‘Love’ and ‘Hate’ in isolation must be regarded. ... t can be seen that, in actuality, also ‘Love’ spans to the skirt of extraordinary force and the darlings, regularly called as affection winged creatures don't appear to think about this power. The genuine encounters may likewise demonstrate the exacting significance of ‘Love’. Presently, on the off chance that we see the exacting importance of ‘Hate’, at that point it implies that ‘an serious and solid abhorrence or antagonistic vibe, which is regularly gotten from outrage, feeling of injury or fear’ (Webster). Essentially as ‘Love’ can be confirm from the various instances of handy life, ‘Hate’ can likewise be demonstrated to be giving a similar importance in the reality, as the writing clarifies. An individual despises some other individual in the event that the person is having some feeling of injury or dread from other individual. This can likewise be called as a passionate trouble since this dread/feel ing of injury makes the ‘Love’ dissipate noticeable all around. Evidently it appears that ‘Love’ and ‘Hate’ don't have any relationship with one another. Notwithstanding, a profound idea is should have been provided so as to break the shell and think other path round. An unclear thought regarding ‘Love’ and ‘Hate’ is probably not going to turn into a wellspring of conviction to demonstrate that ‘Love’ and ‘Hate’ are necessary to one another. There are numerous basic things among ‘Love’ and ‘Hate’. The most well-known thing is that both are exceptional and outrageous sentiments which cause a hearty passionate bond and cause a compelling enthusiastic excitement. Both are identified with immaterial sentiments of feelings. At the point when we take a gander at the connection between the ‘Love’ and ‘Hate’, in the viewpoint/setting of science, at t hat point researchers likewise concoct a thought that ‘Hate’ and ‘Love’ have a slight line in the cerebrum. (Journalist). As per the researcher energy of loathe is equivalent enthusiasm to the sentiments of

Kobe Bean Bryant Essay

Kobe Bean Bryant nicknamed the â€Å"Black Mamba† is an expert ball play who plays in the National Basketball Association (NBA). He was conceived on August 23, 1978. He was drafted directly out of secondary school to play for the Charlotte Hornets, yet before long was exchanged to the Los Angeles Lakers, never playing in Charlotte. Bryant is a five-time champion with the Lakers and a double cross Olympic gold medalist with the USA national group. Bryant was conceived on August 23 in Philadelphia. Bryant was named after a Japanese steakhouse. He is child of a previous NBA player Joe â€Å"Jellybean† Bryant. After the senior Bryant completed his NBA vocation he took his family abroad where he played in an Italian alliance. Experiencing childhood in Italy where soccer was the most well known game Bryant grew up cherishing two games. He would remain the entire day playing soccer on the asphalt handle throughout the day, at that point after all the children returned home he dealt with idealizing his mid-run jumper. Kobe later came back to Philadelphia where he played in secondary school with Lower Merion High School. Peering toward the NBA he exercise with the close by NBA group the Philadelphia 76ers. Kobe chose to skip school and head directly to the NBA. He was drafted by the Charlotte Hornets and along these lines exchanged to the Los Angeles where his vocation lighted. (Biography.com/Kobe Bryant). Kobe Bryant vocation didn't take long to begin in a decent way. In his second year in the NBA as a shooting monitor, at 19 years old, he was casted a ballot to play in the NBA’s top pick game, turning into the most youthful player to show up in the game. Later with the assistance of Shaquille O’neal the Lakers won three successive titles in 2000, 2001, 2002. As he arrived at the prime of his profession without Shaq he had some dreary season as his group didn’t even almost contend at the level Kobe was. He was exceptional on January 22, 2006 he scored 81 focuses and accomplishing the second most elevated scoring game in NBA history, just second to Wilt Chamberlain’s 100 point game. In spite of the fact that his race for a title was not yet over in 2008 he connected up with seven footer Pau Gasol coming to the NBA finals. They didn't win that year however the next year they did in 2009. In 2010 their season was similarly as incredible coming to the NBA fin als for a third consecutive time as Kobe was driving the way. They met their main adversaries again in the games most significant stage. They beat the Boston Celtics in an exciting seven game arrangement. Kobe was named Finals MVP for both of the seasons that they had won the NBA title. He is presently a five-time NBA champion is as yet looking for additional titles. In the 2013 season he turned into the most youthful player to arrive at 30000 focuses at 34 years old. Kobe Bryant is one of the best ball player to ever play the game and will one day be a Hall of Famer. Kobe Bryant has an establishment, â€Å"The Kobe and Vanessa Bryant Family Foundation†, that is devoted to improving the lives of youth and families out of luck, both locally and all around. By giving money related assets and creating one of a kind projects, the establishment endeavors to fortify networks through instructive and social advancement openings. Kobe Bryant is respected by the NBA fans everywhere throughout the world. They love the fervor he carries to game with his unfathomable grip shots and stunning plays. Kobe is likewise appreciated for the assistance he brings to the less lucky. By aiding the monetarily or instructively. By and large Kobe Bean Bryant is somebody you could turn upward to on and off the court.

Essay Topics For Catcher In The Rye - Choosing The Right Topics

Essay Topics For Catcher In The Rye - Choosing The Right TopicsWhen choosing essay topics for catcher in the rye, you need to know what he's trying to achieve. Since this can be seen in many ways, your job is to find out what his project is all about and what his specific goals are for the project. And it all starts with the writing sample that you give him.Be sure to choose topics that coincide with his primary goals. If you're trying to teach him about how to catch a fly ball, make sure to explain to him the meaning of the word catch. Once you've done that, you have to first understand what the meaning of catch really is. Then, try to bring the two together to get to the right meanings.When writing about your children, ensure that the topic matches the primary goals. For example, when you want to teach your son how to catch a fly ball, then you need to start with the meaning of the word catch. After that, you can move on to how to catch a fly ball.In fact, this is exactly what essa y topics for catcher in the rye must do. This is why the first thing you need to do is know what the kids' goals are. They are your kids after all. And if they want to know how to catch a fly ball, they must learn about the meaning of the word catch first.Now, you must also consider that your children don't know the concept of catch. They will likely be having difficulties when learning the basic words. When you give them a subject that will help them learn what the word means, they will be more likely to grasp the concept of catching a fly ball.You must also know that some children will not learn things on their own. This is why you need to use a skill. That's why you need to make sure that you give them examples of what they can do when they catch a fly ball. There are tons of examples that you can use. The one you choose can depend on what your kids want to learn.And finally, you must be sure that you have included things about how the body moves when you catch a fly ball. Kids w ill be able to learn this from the examples you gave them when they learn the concept of catch. There are many ways to train them in this regard.Article writing isn't easy but it can be easy if you know what to do. Try to include topics that coincide with the goals of the project to which the catchers are assigned.

Multisystem Case - Free Essay Example

Sample details Pages: 12 Words: 3515 Downloads: 4 Date added: 2017/09/22 Category Advertising Essay Type Argumentative essay Tags: Study Essay Did you like this example? Running head: MULTISYSTEM CASE Multisystem Case Scenario Demis Russu Section Instructor: Josanne Christian Florida Hospital College of Health Sciences July 22, 2010 Abstract Mr. Jones presents to the ED with a complex combination of symptoms. Clinicians must swiftly evaluate and treat his conditions. Air way protection as well as hemodynamic stability is extremely important. Mr. Jones’s case requires rapid intervention as his condition has been worsening for the past week. Pathology and treatment options are explored to enrich the educational component. Emotional support and long term treatment options must be discussed with Mr. Jones in order to meet his needs. Multisystem Case Study Heart failure (HF) is approaching epidemic levels. The statistics are staggering. Approximately 5 million people are currently diagnosed with HF in the U. S. with 550,000 being diagnosed yearly; health care cost is approaching an exorbitant $28 billion annually (Rasmusson Renlund, 200 6). Chronic obstructive pulmonary disease (COPD) is presently the fourth leading cause of death world wide (Kara, 2005). As nurses it is imperative that we educate patients and their family members on risk reduction, identifying early signs and symptoms and latest treatment advances made towards controlling chronic conditions such as HF and COPD. Scenario Mr. Jones 68 y/o male arrives at the Emergency Department (ED) with complaints of increased dyspnea with exertion for the past three days, weight gain of 6 lbs in the last week, swelling to legs and feet and a noticeable decrease in urination. Mr. Jones does have a history of congestive heart failure (CHF), emphysema, hypertension, Type II diabetes nd rheumatic fever as a child. The patient admits to a long history of cigarette smoking having decreased his smoking to ? a pack daily since being diagnosed with emphysema five years ago. On initial assessment Mr. Jones appeared stated age but fatigued, was alert and oriented to time , place and situation, pupils 3 equal and reactive. Blood pressure 156/94, heart rate 102, rhythm sinus tachycardia, heart tones includes S3 gallop, denies chest pain and peripheral pulses were palpable with weak bilateral post-tibial and dorsalis pedis. Lung sounds were clear upper lobes with crackles in bilateral lower lobes, patient is dyspnic on exertion. Pulse oximeter 88% on room air, oxygen was applied at 2 l/m via nasal cannula which improved oxygen saturation to 94%. Abdomen obese had positive bowel sounds in all four quadrants, non-tender, non-distended, last bowel movement was yesterday morning. Mr. Jones reports a decrease in urinary frequency as well as amount, recalls urinating very small amount twice daily in the past two days. Skin was intact, has 3 + bilateral lower extremity edema. Mr. Jones reports the following medication regime: Altace 5mg PO twice daily, Toprol XL 25mg PO daily, Aldactone 25mg PO daily, Advair Diskus 250/50 mcg inhaler twice daily and Spi riva 1 cap inhaled daily. Mr. Jones reports that he has not taken his medications in the past 7 days because he did not have the money to purchase them. The ED physician orders the following tests: complete blood count, complete metabolic profile, thyroid level, lipid profile, homocysteine levels, Troponin I every 8 hrs x 3, BNP, HGBA1C, ABG, EKG, CXR, 2D Echo and a Cardiology consult. Order for Lasix 40 mg IV every 8 hrs with the first dose to be given stat was written. A urethral catheter was inserted in order to maintain strict IO and 1500 ml fluid restriction was ordered. Chronic Disease Review: Congestive Heart Failure Definition According to Brashers heart failure affects 10% of the population over the age of 65 and is the most frequent reason for hospital admission in this age group (2008). HF encompasses several types of cardiac malfunction which results in insufficient blood supply to the body’s tissues and organs. The most common cause of HF results from left ventricular dysfunction which includes both systolic and diastolic heart failure. Right ventricular dysfunction (also known as cor pulmonale) in the absence of left ventricular dysfunction can be attributed to pulmonary disease such as emphysema which is also referred to as COPD. Signs and Symptoms Signs and symptoms of left heart failure result from pulmonary vascular congestion and insufficient perfusion to tissues and organs. Brashers describes patients experience fatigue, edema, decreased urine out put dyspnea, orthopnea, and frothy sputum (2008). Physical exam will reveal pulmonary edema, hypertension or hypotension, S3 gallop and possible evidence of acute or chronic CAD. Mr. Jones did present fatigued with dyspnea on exertion, crackles bilaterally, he does have an audible S3 gallop, and blood pressure is 156/94. Edema of the bilateral lower extremities is evident at 3+ as well as Mr. Jones reports a 6 lb weight gain in the past week as well as decreased urine output. Pa thophysiology Systolic heart failure (SHF) is the inability of the heart to produce a cardiac output sufficient enough to perfuse major organs and tissues. Cardiac output depends on the heart rate and stroke volume. Stoke volume is affected by contractility, preload and afterload (Brashers, 2008). Contractility is affected by disease processes such as myocardial infarction, myocarditis, cardiomyopathies, myocardial ischemias, and inflammatory, immune or neurohumoral changes. According to Brashers preload increases due to excess in vascular volume which can result from intravenous fluid administration, renal failure and mitral valvular disease (2008). Frank-Starling’s law states that increasing the ventricular end-diastolic volume will cause a stretching effect of the myocardium causing a stronger contraction which results in improved cardiac output; however prolonged increased preload will ultimately lead to decreased contractility as this myocardial stretching will cause sarcomere dysfunction. Aortic valvular disease or hypertension is responsible for increases in afterload. Persistent increased peripheral vascular resistance leads to ventricular hypertrophy. Brashers explain hypertrophy results in deposition of collagen between myocytes, causing ventricular remodeling consequently reducing the contractility properties of the myocardium resulting in a dilated and less compliant ventricle (2008). The vicious (in this case) rennin-angiotensin-aldosterone system gets activated by poor cardiac output and decreased renal perfusion. Our body’s natural instinct to maintain homeostasis is stimulated. Barrow receptors which detect a decrease in perfusion stimulate the sympathetic nervous system to cause further vasoconstriction and antidiuretic hormone is release by the hypothalamus causing the kidneys to hold on to fluid. Mr. Jones fits the above criteria exhibiting symptoms of dyspnea, edema, has the classic HF murmur S3 gallop, is hypertensiv e and reports decreased urine out put with weight gain. Diastolic heart failure (DHF) is associated with delayed relaxation and increasing left ventricular rigidity which prevents adequate filling and decreases the ability to properly eject blood (Redderson, 2008). DHF occurring singly is described as pulmonary congestion with a normal cardiac output and stroke volume. Brashers describes DHF as the causative condition of 40% to 50% of all cases of left heart failure with a higher incidents in women (2008). Increased pressure at the end of diastole in the left ventricle is reflected back within the pulmonary circulation causing pulmonary congestion. Causes of DHF include myocardial ischemia, left ventricular hypertrophy induced by chronic hypertension, valvular diseases, cardiomyopathies and pericardial diseases. During exercise individuals with DHF are not able to compensate for the increased demands, therefore the heart is not able to increase cardiac output since the left ve ntricle is hypokinetic. Signs and symptoms include dyspnea on exertion, fatigue, evidence of pulmonary edema, hypertension coronary disease and valvular disease (Brashers, 2008). Mr. Jones could have DHF as he does present with appropriate symptoms however his symptoms are more indicative of SHF and the test results will help differentiate between the two. Right heart failure may result from left heart failure due to increased pressures in the left ventricle which reflects back into the pulmonary circulation. The right ventricle is not designed to cope with high pressures therefore it hypertrophies and fails. In the absence of left heart failure the cause is related to hypoxic pulmonary disease such as COPD, ARDS and cystic fibrosis causing pulmonary hpertension. Cardiac related conditions which affect contractility include pulmonic valvular disease, myocardial infarction, and cardiomyopathies (Brashers, 2008). Sings and symptoms include decreased cardiac out put during exerci se; EKG shows right ventricular hypertrophy, jugular venous distension, peripheral edema and hepatosplenomegalaly. Mr. Jones has a long history of smoking and he continues to smoke despite being diagnosed with emphysema five years ago. Tobacco use is the primary risk factor for developing COPD. Mr. Jones’s symptoms as well as his history and risk factors support a combination of left heart failure as well as right heart failure. Diagnostic Screening and Evaluation: Radiographic Laboratory Diagnostic blood work is ordered in order to support the condition suspected and rule out other conditions that may mimic HF, as well as to determine the severity of HF. EKG will identify the heart rhythm, right ventricular hypertrophy as well as conduction abnormalities or myocardial infarction. BNP level is an indicator of B-type natiuretic peptide which is secreted by the heart in order to maintain fluid balance, elevated levels support HF. CBC will rule out anemia and infectious proc esses. CMP will give us an indication of electrolyte status, renal, hepatic and pancreatic function. Thyroid profile will show thyroid function, as it can also affect cardiac function, lipid profile will show good and bad cholesterol levels. HGBA1C shows glycemic control for the past 3 months, ABG will demonstrate respiratory and metabolic status. Cardiac enzymes will determine if Mr. Jones is actively experiencing a myocardial infarction. CXR can support pulmonary congestion along with cardiomegally infiltrates, pleural effusion as well as differentiate COPD. A 2D Echo will show valvular function, kinesis of the myocardium as well as ejection fraction. Cardiology consult is requested because cardiologists are specifically trained to treat HF. Mr. Jones’s results were as follows: CBC, thyroid levels are normal; CMP shows elevated creatinine which indicates renal insufficiency. Lipid profile supports hyperlipidemia. Cardiac enzymes are negative, BNP is grossly elevated, and HGBA1C shows very poor glycemic control for the past three months. ABG shows a compensated pH with a PaO2 of 69. CXR reveals cardiomegally, and gross pulmonary congestion, EKG sinus tachycardia, right ventricular hypertrophy. Echo cardiogram confirms an EF of 30% and right and left ventricular hypertrophy and mitral valve stenosis. In 2001 and again in 2005 the American College of Cardiology (ACC) and the American Heart Association (AHA) collaborated to create a frame work which allows providers to understand the progression and HF. Heart failure progression is defined in four stages A, B, C, and D, beginning with at risk patients all the way to end-stage disease (Rasmusson, 2006). Treatment Interventions Rationale Dr. Heart reviews all the available information and places Mr. Jones in Stage C class of HF. Mr. Jones exhibits acute decompensated symptoms such as dyspnea, lower extremity edema, pulmonary congestion, remodeling of the left ventricle from chronic hypertension resulting in structural changes. Also important to mention are the co-morbidities, such as Diabetes and COPD. According to Rasmusson treatment options must focus on reduction of morbidity and mortality. Pharmacologic agents include ACE inhibitors, ARBs, beta-blockers and aldosterone antagonists, as well as diuretics and digoxin. Treatment goal is to block neurohormones preventing the cycle of decreasing contractility, increasing preload and afterload, and relieving pulmonary congestion (2006). In the acute treatment phase emphasis is placed on stabilizing hemodynamics, correcting fluid volume, determination of etiology, and reversing conditions that can be reversed. Long term care includes vital patient and family education, appropriate titration of pharmacologic agents, salt restriction, and possibly cardiac resynchronization therapy (CRT). CRT refers to bi-ventricular pacing which allows synchronization of the left ventricle consequently improving the ejection fraction (EF) which is normally 55%-70% (Brashers, 2008). Patients with an EF . 12 seconds are at a high risk for arrhythmias and sudden cardiac death therefore an implantable cardiac defibrillator is recommended (Rasmusson, 2006). Treatment for DHF focuses on improving ventricular relaxation, and prolonging diastolic filling times in order to reduce diastolic pressure. Inotropic drugs are not indicated in isolated diastolic heart failure since contractility and EF are not affected although digoxin may be used in patients with atrial fibrillation in order to achieve rate control (Brashers, 2008). Prevention Mr. Jones presented to the ED with exacerbation of HF related to non-compliance with medication regime. In this case patient education is of up-most importance. Hospitalization prevention is important due to the exorbitant costs. Patient education will focus on medication compliance, and signs and symptoms of exacerbations. Having the ability to recognize early symptoms will allow Mr. J ones to visit his physician, which could adjust the medication regime, impose a fluid and salt restrictions, as well as provide aggressive diuresis at the office in order to prevent a hospital admission. A social worker consult should be arranged in order to provide assistance with indigent issues. Chronic Disease Review: COPD or Emphysema Definition Chronic obstructive pulmonary disease includes pathologic lung changes consistent with emphysema or chronic bronchitis (Brashers, 2008). There is a permanent enlargement of gas exchange airways in conjunction with destruction of alveolar walls with out apparent fibrosis. Loss of elastic recoil is the causative factor of airflow limitation. The major cause of COPD is cigarette smoking even though childhood respiratory infections and air pollution are known to be contributing factors (Brashers, 2008). Signs and Symptom Clinical manifestations of COPD include, dyspnea, wheezing, and prolonged expiration. Individuals will have a classic barrel chest appearance. Late in the course of COPD patients will experience chronic hypoventilation, polycythemia and cor pulmonale also known as righ heart failure. Fatigue, weight loss, poor appetite as well as sleep disturbance may occur. Mr. Jones does have dyspnea, however it is unclear if it is related to the HF or COPD, nonetheless his history and test results do support a combination of conditions all exacerbated by his non-compliance with the prescribed medication regime (Kara, 2005) Pathophysiology The irreversible process begins with destruction of the alveolar septa consequently increasing the volume of air in the acinus. Pollutant particles stimulate inflammation resulting in alveolar destruction and loss of elastic recoil of the bronchi. This destruction produces bullae and blebs which are not effective in gas exchange resulting in hypoxemia due to ventilation – perfusion mismatching. The loss of elastic recoil reduces the volume of air that can be expire d making expiration difficult and causing air to become trapped in the lungs. Hyperexpansion is the result of trapped air, which stresses the muscles of respiration, therefore late in the course of disease hyperventilation and hypercapnia develops (Brashers, 2008). In non-smokers and individuals who develop the diseases before the age of 40 the causative factor is a rare genetic condition, which involves a deficiency of ? 1- antitrypsin which does not inhibit proteolysis in the lung tissue (Kara, 2005). Diagnostic Screening and Evaluation: Radiographic Laboratory Pulmonary function testing, arterial blood gas, high-resolution computed tomography and chest x-ray are used for diagnoses. Pulmonary function measurements, such as vital capacity (VC) and particularly forced expiratory volume (FEV1) are helpful in determining the stage of the disease. In 1998 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to generate recommendations for COPD manage ment based on the latest scientific evidence available to date (Kara, 2005). COPD can be classified into four stages Stage I – Stage IV, from mild where the individual is not even aware the condition exists to very severe where essentially respiratory failure is present based on the results of FEV1 and patient’s symptoms. Mr. Jones appears to be in Stage II to Stage III due to fatigue, shortness of breath and recent exacerbation. Again important to mention is that Mr. Jones has multiple processes involved therefore his symptoms are caused by a cumulative effect. Treatment Interventions Rationale Treatment for COPD is based on primary prevention, relieving symptoms, improvement of over all health status and exercise tolerance, diligent treatment of exacerbations and complications (Kara, 2005). Educating on smoking cessation and ensuring immunizations are up to date is crucial. Acute and chronic symptoms will be managed with bronchodilators such as ipratropium and B2 -agonists, in severe cases the use of methylxanthines, intravenous, inhaled or oral steroids and home oxygen may be required. Adequate nutrition is also very important. Lastly pulmonary rehabilitation is aimed at improving functional capacity and quality of life (Kara, 2005). Mr. Jones exacerbation of symptoms is related to medication non-compliance and continued smoking. Nebulizer treatments with DuoNeb (albuterol/ipratropium) every 4 hrs and prn via nebulizer and steroids would decrease the severity of symptoms. In the event that tachycardia persists a switch to Xopenex/ipratropium would be beneficial, as Xopenex has less incidence of inducing tachycardia. Supplemental oxygen was applied upon pulse oximetry reading. Antibiotic therapy would be considered if there were signs of infectious processes. Prevention Prevention focuses on patient education and medication compliance. Assessment of Mr. Jones’s cognitive status is important to facilitate educational conversation that he would understand. Indigent support in order to encourage medication compliance is important although realistically not always available. Chronic Disease Review: Rheumatic Fever Definition Rheumatic fever is an inflammatory disease caused by the group A ? -hemolytic streptococcus, characterized by inflammation of the joints, nervous system and heart. When not appropriately treated, rheumatic fever will cause scarring and deformity of cardiac structures (Brashers, 2008). Signs and Symptoms Rheumatic fever often exhibits symptoms that are common to other conditions such as nausea, vomiting, abdominal pain, fever, arthralagia, lymphadenopathy and epitaxis and fever. According to Kara the American Heart Association and the World Health Organization developed the following criteria for diagnosis purposes: carditis, erythema marginatum, acute migratory polyarthritis and chorea (2005). Pathophysiology Rheumatic fever occurs as a consequence to a pharyngeal infection by group A ? -hemolytic streptococcus which causes an abnormal humoral and cell-mediated immune response. Brashers explains; the immune response cross-reacts with molecularly similar self-antigens on brain, muscle, heart and joints resulting in an autoimmune response that inflames and potentially scars these tissues (2008). The inflammation may subside before treatment; however damage to the heart valves remains. Individuals with CHF and pericarditis suffered significant damage. Endocardial inflammation can cause swelling of the valve leaflets and aggregation of clumps of vegetations containing platelets and fibrin become deposited on valvular tissues causing stenotic valves. If the inflammation is able to penetrate the myocardium it may cause carimegally and left heart failure due to fibrin deposits also known as Aschoff bodies (Brashers, 2008). According to the test results Mr. Jones has mitral valve stenosis, cardiomegaly and HF. Unfortunately Mr. Jones had rheumatic fever as a child w hich may be the causative factor of his HF. Diagnostic Screening and Evaluation: Radiographic Laboratory In the acute phase rheumatic fever is diagnosed based on clinical symptoms plus by positive throat culture for grop A ? -hemolytic streptococci, antistreptolysin O antibody titers 250 Todd units, elevated values of anti-DNase B, antihyaluronidase, antistreptozyme, WBC, ESR, and CRP (Kara, 2005). Treatment Interventions Rationale Therapy is focused on eradicating the streptococcal infection trough appropriate antibiotic therapy. Other pharmacologic agents include NSAIDS, cardiac glycosides, corticosteroids, and diuretics (Brashers, 2008). In the event that there is significant hemodynamic instability related to damaged valves than surgical intervention may be required. Conclusion In conclusion Mr. Jones presents with an intricate combination of symptoms requiring a systematic approach with focus on alleviating symptoms, and educating the patient on preventative measures. I s the history of rheumatic fever a key factor in the patient’s extremely poor condition? It may very well be a component of Mr. Jones’s issues. Risk factors such as poor glycemic control, smoking, and poor nutritional status in addition to the co-morbidities associated with COPD, Diabetes, hypertension, hyperlipidemia and HF certainly add to the severity of the situation. Serious consideration needs to be given to quality of life issues, at this point a Living Will and Code Status should be discussed with Mr. Jones. Frequent hospitalizations and chronic conditions can place a big burden on resources as well as emotional well being. Mr. Jones may requires rehab prior to discharge home, or even decide to try a long term placement facility for better medical management of his condition. Mr. Jones may require a surgical consult for valve replacement and/or a cardiology consult for a bi-ventricular pacer / automated implantable cardiac defibrillator. Much emphasis nee ds to be placed on education; most importantly smoking cessation, identifying early signs and symptoms of HF and COPD exacerbation and medical regime compliance. As nurses we have to quickly identify educational opportunities and provide our patients the necessary tools for them to actively accomplish positive and therapeutic change. As nurses we are often the first and last row of defense for our valuable patients. References Brashers, V. L. 2008). Alterations of cardiovascular function. In S. Huether, K. McCance, (Ed. ), Understanding pathophysiology (4th ed. ) (pp. 606-675). St. Louis: Mosby Elsevier. Brashers, V. L. (2008). Alterations of pulmonary function. In S. Huether, K. McCance, (Ed. ), Understanding pathophysiology (4th ed. ) (pp. 693-713). St. Louis: Mosby Elsevier. Kara, M. (2005). Preparing nurses for the global pandemic of chronic obstructive pulmonary disease. Journal of Nursing Scholarship, 37(2), 127-133. Retrieved from CINAHL database. Rasmusson, K. , Hall, J. , Renlund, D. (2006). Heart failure epidemic: boiling to the surface. Nurse Practitioner, 31(11), 12. Retrieved from CINAHL database Redderson, L. , Keen, C. , Nasir, L. , Berry, D. (2008). Diastolic heart failure: state of the science on best treatment practices [corrected] [published erratum appears in J AM ACAD NURSE PRACT 2008 Nov;20(11):576]. Journal of the American Academy of Nurse Practitioners, 20(10), 506-514. Retrieved from CINAHL database. Roodpeyma, S. , Kamali, Z. , Zare, R. (2005). Rheumatic fever: The relationship between clinical manifestations and laboratory tests. Journal of Paediatrics Child Health, 41(3), 97-100. doi:10. 1111/j. 1440-1754. 2005. 00557. x. Don’t waste time! Our writers will create an original "Multisystem Case" essay for you Create order

A Research Plan For A Business Strategy - 935 Words

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Morality and Social Policy - 1205 Words

Morality and social policy According to ADDIN EN.CITE Noonan1970705Noonan (1970)7057055John T. NoonanJohn T. Noonan, JrAn Almost Absolute Value in HistoryThe Morality of Abortion: Legal and Historical Perspectives51-591970CambridgeHarvard University Press HYPERLINK l _ENREF_2 o Noonan, 1970 #705 Noonan (1970), anyone conceived by a man and a woman is human and by recognizing this fact, it is inhuman to kill the fetus despite its imperfections. He also presents the argument that by limiting humanity to exclude certain groups which comes from allowing abortion as a result of imperfections in the fetus risks creating precedence in allowing certain groups to be excluded in society. The author also states that the moral analysis conducted in his essay comes from the perception of the fetus humanity and the weighting that is given to the fetal rights against other fundamental human rights. 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Small Business Management Question Tips With Answer Solution

Questions: 1. Frank Rainsford has been, in effect, the CEO of Franks All-American BarBeQuesince its inception. His major role has been that of restaurant manager, receiving support from his assistant manager Ed Tobor for the last fourteen years. Frank has two children, a son and daughter, who both worked in the restaurant as teenagers. His daughter has worked periodically at the restaurant since she graduated from high school. Franks son, who recently lost his job, has returned to work for his father. The son produced several plans to expand the business, including the opening of a second restaurant and the extensive use of social media. After careful consideration, Frank has decided to open a second restaurant, but this has presented him with a major problemhow to assign responsibilities to personnel. His son wants to be designated the restaurant manager of the second restaurant and made the vice president of marketing. Ed Tobor also wants to be the manager of the new restaurant. His daughter has expressed an interest in being the manager of either restaurant. How should Frank resolve this problem? 2. One night after the restaurant had closed, Frank Rainsford sat down with his son, Robert. Frank had finished reading his sons business plan for a third time. Robert sensed that his father had some sort of reservations. Whats the matter, Dad? Didnt you like the plan? Frank paused and said, Bobby, from a technical standpoint I think you have done a very, very credible job, but you are right. I do have some concerns. Disappointed, Robert asked his father to lay out his concerns. Frank told him that opening another restaurant was a huge and expensive undertaking. He knew that Robert understood the financial risks, but he was not sure that his son understood the problems associated with getting people to come to a new restaurant. Frank was straightforward and told his son, I have been at this for thirty-plus years. It took me years to build up my client base. I really know my customers and what they like. Up until this year the only marketing I did was flyers and a few ads in the local paper and the church bulletin. How are we going to understand our customers at the new location? We are going to have to fill itup quickly if we are to pay the bills. I know Ive had some good success with selling the sauces during the last few years, but remember that Im selling them from Harrys grocery store. His customers already know me and my product. Your plans for ramping up sauce sales are great, but again, how are we going to get people to know who we are and interested enough to by a six dollar bottle of barbecue sauce? Frank went on to tell his son that he knew that Robert was extremely knowledgeable about marketing and the use of the Internet. He reminded Robert that he had given him a greatly enlarged marketing budget in 2010. If you were Robert, how would you go about alleviating your fathers concerns? (You may want to consult Chapter 16 "Appendix: A Sample Business Plan" and review Roberts business plan for a new restaurant.) Answer the question from a marketing persp ective. 3. Locate the average values of these values for the restaurant industry and comment on how well or poorly Franks All-American BarBeQue appears to be doing with respect to the industry. Answers: 1. In the given case scenario, Frank Rainsford, the CEO of his BarBeQue restaurant had Ed Tobor as an assistant manager for the last fourteen years. Evidently, he qualifies for the post of manager at Franks new restaurant as he has gained exquisite experience. Also, he knows the business inside out as he has worked for Frank as a substantial support. Franks children have been away while Robert was working for another organization and not at the restaurant. He holds a BS degree in marketing and lost his job after which he decided to contribute to his fathers business. Franks daughter Susan worked at his restaurant as a teenager during summer vacations. It is observed that both the kids, Robert and Susan want to be designated as the manager of Franks new restaurant. Under functional organizational structure, the organization has different groups or functional areas such as marketing, operations and others (Karatepe and Kilic 2015). Ed Tobor who has contributed his fourteen years expres ses his interest in being the manager of either restaurant. It is argued that Ed Tobor knows the business inside out and must be made the manager at the new restaurant. In a new restaurant, Frank requires a qualified professional who could successfully delegate tasks to the personnel. Susan must be made the assistant restaurant manager where she can gain experience and qualify for a higher position. Robert must be made the vice president of marketing that would help Franks All-American BarBeQue in reaching new levels (Martin et al. 2012). 2. As stated in the given scenario, Frank is concerned about the marketing standards for attracting customers at the new location of restaurant at Connecticut. So far, the customers at the previous location have known Franks product at Harrys grocery store. However, from the marketing perspective, Frank needs to be explained about Roberts business plan. Frank needs to understand that thirty years back when he started the business of selling sauces, he needs to compete through the modern methods of communication. Robert must enlighten Frank with the benefits of internet and web marketing. For selling the sauce at six dollar per bottle, the advertisements can overcome the barriers of reach through internet. Online marketing shall also help in targeting the suburban population where the market needs to be divided into various demographic regions (Annunziata and Vecchio 2013). The customers can express their concerns or interests which can be addressed by Robert at a later stage. The eas e of marketing through internet is enhanced as the products can be browsed at any time. The details of the products can be viewed by the customers without having them visit the store. Campaigns may be generated for attracting the customers. Internet is a platform for building relationship with the customers which would also help in improving retention. Emails can be made to customers for maintaining relationships using personalized offers. Robert must further explain about the tracking results for growth, leads and sales conversions from the marketing search campaigns (Hidayanto et al. 2012) 3. There are different values which can be used to measure the wellness of Franks All-American BarBeQue restaurant with respect to the restaurant industry. They are: Asset Approach- According to the asset approach, the method seeks to determine the business value on the basis of valuation of assets. It is analyzed that Franks business is doing well because the long-term assets have a fair value. Also, the company has substantial cash, inventory and other assets to maintain a positive balance (Wu 2013). Market Approach- The market approach or the pricing multiples help in determining potential selling price, revenue or profits. According to the market analysis, the potential customers have a significant market share when it comes to buying sauces. Frank is doing well as the barbecue food is served at a reasonable price and is sold in a family-friendly manner (Ha and Jang 2013). Income Approach- This approach helps in determining the value of a business based on the ability for generating desired economic benefit for the owners. This approach helps in determining the business value as a function of profitability or economic benefit. Based on the data and figures given in the case study, both 2009 and 2010 were crucial for the restaurant industry. There would be stiff price competition and the level of personal income was estimated to grow in both 2011 and 2012. Therefore, the value in terms of income approach falls on the positive side as the people shall spend for eating at Franks restaurant or buying the barbecue sauce (Ha Jang 2013). References Annunziata, A. and Vecchio, R., 2013. Web marketing strategies of food producers in Italy: a competitive analysis.International Journal of Internet Marketing and Advertising, 8(1), p.1. Ha, J. and Jang, S., 2013. Attributes, consequences, and consumer values.International Journal of Contemporary Hospitality Management, 25(3), pp.383-409. Hidayanto, A., Adha, M., Jiwanggi, M. and Melia, T., 2012. A study of impact of search engine optimisation to internet marketing strategy.International Journal of Services, Economics and Management, 4(4), p.298. Karatepe, O. and Kilic, H., 2015. Does Manager Support Reduce the Effect of WorkFamily Conflict on Emotional Exhaustion and Turnover Intentions?.Journal of Human Resources in Hospitality Tourism, 14(3), pp.267-289. Martin, R., Muls, M., de Preux, L.B. and Wagner, U.J., 2012. Anatomy of a paradox: Management practices, organizational structure and energy efficiency.Journal of Environmental Economics and Management,63(2), pp.208-223. Wu, H., 2013. An Empirical Study of the Effects of Service Quality, Perceived Value, Corporate Image, and Customer Satisfaction on Behavioral Intentions in the Taiwan Quick Service Restaurant Industry.Journal of Quality Assurance in Hospitality Tourism, 14(4), pp.364-390.