Pain Management and Post Operative Care Case Studies

Pain Management and Post Operative Care Case Studies This is a scenario based essay in which two scenarios will be looked at. One is on osteoarthritis and osteoporosis patient and the other one is based on oesophageal reflux disorder and peptic ulcer disease. The clinical manifestations of these two health problems and post-operative care of patients with these issues will be discussed in this paper. Complications of gastric diseases here in will also be discussed Osteoporosis also known as porous bone or fragile bone is a chronic form of metabolic bone disease characterized by a significant weakening in the structure of bone tissue and a low bone density (Brown and Edwards, 2012).This occurs when there is an imbalance between the bone formation and bone resorption. Under normal circumstances, osteoblasts constantly deposit bones which are resorbed by osteoclasts. This process is termed remodelling. In this case, the rate of deposition equals that of resorption such that for the total bone mass remains constant .However in osteoporosis, the bone resorption exceeds bone formation which leads to thin, fragile bones that are subject to spontaneous pathological fracture ( Craft et al,2011 ).Osteoporosis has some risk factors which are classified as modifiable and non-modifiable risk factors. Some of the modifiable risk factors include; low birth weight, cigarette smoking,malnutrition,low calcium intake, deficiency of vitamin D, deficit of oestroge n or androgen ,poor physical activity, some medications like steroids, anticonvulsants , vitamin A, and chronic conditions like thyroid, liver diseases as well as diabetes while the non-modifiable ones are race,sex,advanced aged,genetics,dementia, previous fractures as an adult(Kenny and Karen,2013).Osteoporosis is often regarded as a silent disease. This is because during the early stage, the bone loss is usually asymptomatic. At this point, Claire may not realise that she has osteoporosis but as the disease progresses, her bones become weaker such that even a slight or sudden bump or fall results to a fracture of either the hip, vertebral or wrist.However,Acute back pain is one of the earliest clinical manifestations Claire will be experiencing. This occurs due to vertebral compression fracture. Groin or thigh pain may also occur due to hip fracture (Brown and Edwards, 2012). Osteoarthritis on the other hand develops when the articular cartilage that protects the ends of bones in a joint begins to disintegrate. This disorder is more prevalent among the elderly and regarded as part of their aging process. Any localized wear and tear may hasten the situation and its symptom may be confined only in one joint. Early in the disease, the cartilage starts to break becoming roughened and thinner thereby interfering with easy movement.Cytokines which stimulate the release and production of an enzymes called protease are released( LeMone et al,2011)). This enzyme causes increase in the disintegration of the cartilage. To this end, the subchondral bone becomes damaged and exposed while cysts and osteophytes spurs developed around the margin of the bone. Osteophytes piece and cartilage starts to break off into the synovial cavity which further causes irritation and makes the joint space narrower. This exposes the bony surfaces hence they, rub against each other causi ng pain thus making the affected joint to become inflamed frequently (LeMone et al, 2011). Osteoarthritis has many clinical manifestations occurring due to body’s response to this degenerative change which ranges from mild discomfort to major disability. ( Brown and Edwards, 2012).some clinical manifestations Claire may experience may include joint pain.and swelling. It occurs due to weight bearing and movement. The pain may be unilateral and eventually becomes more severe as the degenerative changes progresses (Brown and Edwards, 2012 ).During the initial stage, this pain can be relieved by rest but as the disease advances, the pain may occur even at rest and Claire’s sleeping pattern may be interrupted as a result of joint discomfort. This joint discomfort may become more severe following a change in weather condition (Brown and Edwards, 2012).There will be limited joint movement due to loss of cartilage which is irregular and worn and osteophytes developed. Also crepitus may be heard as the joints become irregular, rubbing against each other.Towards the en d or middle joint of fingers, Claire may develop bony lumps known as herberden and bouchard nodes leading to structural deformity. (Brown and Edwards, 2012). Following Claire’s fracture repair, her post-operative nursing care and management are directed towards promoting safety, monitoring vital signs and applying the general principles of post–operative nursing care. The nurse will ensure that all the necessary safety equipment’s are near the patient’s bed side and in good working condition in case of emergency. Assess patient’s airway, circulation and breathing sounds for patency and check vital signs and pulse oximetry for baseline (Perry et al, 2012). Determine patient’s pain level using the pain rating. This will reveal the nature of pain and as well direct the nurse towards suitable interventions. Assessment of Claire’s neurological status is also of paramount important to ascertain the level of consciousness and movement of extremities (Perry et al, 2012). Observe IV access for patency and signs of infection, noting the rate to avoid insufficiency and overload. Check catheter drainag e for patency, colour, amount, ensuring frequent emptying and proper documentation in the intake and output chart (Perry et al, 2012). Also neurovascular assessments of the affected extremity are very important in order to detect changes while movement restraints or activities related to the turning, positioning and extremity support should be monitored closely and proper alignment and positioning to minimize discomfort and pain should be encouraged. Also, cast or dressings should be observed closely for signs of bleeding or drainage. It is pertinent to note that, any significant increase in the size of the drainage should be reported and documented (Perry et al, 2012). It is expected that Claire’s mobility will be impaired following surgery. Therefore, frequent assessment of common complications of immobility like pressure sore formation, renal calculi, deep vein thrombosis, pneumonia, paralytic ileus and pulmonary embolism are necessary and appropriate measures taken to alleviate it must be taken. Some of these measures include two hourly change of patient’s position according to hospital policy .This can be done by assisting in repositioning while stabilizing the fracture site (Lewis et at,2006).Other measures can be deep breathing and coughing exercise, active range of motion exercise, providing TED socks as well as early ambulation. Immobilization of the elbow to prevent wrist supination and pronation is necessary while the nursing management should include steps to prevent or reduce oedema and regular neurovascular assessment. Extremity should be supported and protected along with active movement of the fingers and thumb. This ex ercise helps reduce oedema, avert stiffness and increase venous return (Lewis et al, 2006). Active movement of the shoulder to prevent stiffness or contraction should be frequently performed by patient and must be encouraged. Deep venous thrombosis and subsequent pulmonary embolism which may occur due to venous pooling can be alleviated by using techniques to promote lower limb blood flow. Electrical stimulation induced contractions have been shown to improve skeletal muscle movements preventing venous stasis and oedema (Broderick, 2010). Regularly assessing the pin insertion sites and providing pin site care as per hospital policy is highly important and any signs of infection like redness, purulent drainage and increases tenderness must be reported and documented ( LeMone et al,2011). Prescribed medications such as antibiotics and analgesics per physicians order must also be administered and charted. The patients may also require assistance with ADLs especially where the stronger hand is the one affected (Farrell Dempsey, 2011). Following Claire’s complain of pain, it is important to assess patient’s level of comfort and the character of her pain. This can be done by asking her about the precipitating factor, quality, radiation ,severity and timing and also asking patient to rate the pain level using a scale of 1 to 10.All this measures will assist to determine the type and level of pain the patient is experiencing and to decide the type and dose of prescribed analgesic that will best suit patients pain where there is a choice .It can also help to decide whether her pain can be managed with non- pharmacological measures like arm elevation, ice application or even finger exercises (Perry et al, 2012 ). After these measures have been taken, neurovascular status fine and patient still in severe pain, the nurse will check the last time patient was given analgesic, route ,dose, frequency and as such its effectiveness .This is to determine the need for another dose and if the dose need to be increase d. However, before administration, the order must be checked by two nurses, the six rights of medication administration observed and patient’s identity confirmed using two identifiers such as name and date of birth for safety. After administration, the nurse will re-assess patient for effectiveness (Perry et al, 2012). Following Claire’s fracture and surgical procedure, some of the post-operative complications she may experience include compartment syndrome, fat embolism, deep vein thrombosis, pneumonia, pulmonary embolism, pressure sore, paralytic ileus, renal calculi, loss of appetite. This potential problems can be prevented by early ambulation which will help promote muscle tone, improve urinary and GIT, promote circulation to eliminate venous stasis and hasten wound healing (Mak et al, 2010). Additionally, problems associated with bony union and possible infection may occur. If adequate muscle and tissue coverage is not achieved following muscle and flap grafts, amputation may be needed (Mak et al, 2010). SCENARIO TWO Gastroesophageal reflux disease is a condition caused by the reflux of gastric contents into the oesophagus which aggravates symptoms and alters ones quality of life. This structural change produces heartburn and regurgitation. Reflux occurs when the lower oesophageal sphincter pressure is deficient or pressure in the stomach exceeds the lower oesophageal sphincter pressure. This leads to reflux of acid, bile, pepsin and pancreatic enzymes thus resulting to an injury in the mucosal lining (Giorgi et al 2006). Peptic ulcer disease generally known as painful sore or ulcers is most commonly found in the proximal duodenum and also in the antrum of the stomach or lower oesophagus (Brown Edwards, 2012). Normally, water, electrolytes and water soluble substances like glucose pass freely through the mucosal barrier while acids and pepsin are denied entry. This defence mechanism can be altered in certain conditions allowing backflow of acid and pepsin. As hydrochloric acid or pepsin penetrates the mucosal barrier, the tissues are exposed to continue damage due to acid diffuses into the gastric wall. Ulcers may erode more deeply into the muscularis and then perforate the wall. As erosion invades the blood vessel wall, bleeding takes place (Brown Edwards, 2012). This peptic ulcer disease has various clinical manifestations. Pain is one of the symptoms patient is experiencing. Its nature is typically described as burning, gnawing, aching or hunger-like and is often felt in the epigastric region, sometimes radiating to the back mainly when the stomach is empty (WebMD,2014). The pain is usually relieved by eating or by ingestion of antacids. Other symptoms the patient may be presenting with are loose of appetite and weight loss, heartburn or regurgitation, vomiting. Chest pain or dysphagia, anaemia. As patient’s condition become more severe, there may be malaena .This occurs due to bleeding from perforated mucosal wall.Haematemesis may also result (Brown Edwards, 2012). Helicobacter pylori infection are amongst the most common cause of peptic ulcer disease which directly and indirectly weakens the protective mucosal lining of both the stomach and duodenum allowing easy access of acids to the sensitive areas. As this happens, the lining becomes irritated and wears off resulting to sore formation (Duggan Duggan, 2006). Other factors includes excessive intake of NSAIDS such as aspirin or ibuprofen,genetic,smoking,high consumption of alcohol and coffee, liver or lung diseases, starvation, stress and certain diets(Duggan Duggan,2006). Histamine 2 receptor blockers like ranitidine are indicated for a patient with peptic ulcer disease. These drugs act by inhibiting histamine binding to the receptors on the gastric parietal cells to reduce or stop secretion. Proton pump inhibitors such as omeprazole which stops the acid secreting enzymes functioning as proton pump, disabling them for a period of 24hours also provides effective pain relief and promotes rapid ulcer healing (Brown Edwards, 2012). Antacids also stimulate gastric mucosal defences thereby aiding in ulcer healing. Other mucosa agents that can be helpful include sucralfate, Bismuth compounds and prostaglandin analogs (Brown Edwards, 2012). Many disease conditions can present with symptoms found in peptic ulcer thus making its diagnosis difficult. However to avert this, certain diagnostic procedures such as gastroscopy and colonoscopy need to done and the nursing care of a patient undergoing these procedure shall be explained in this part of the paper. Firstly, the nurse will ensure that consent is obtained, explain procedure to the patient, informing the patient his role.Prepre patient’s bowel by checking when last patient eat or drink, ensuring patient is on nil by mouth for 8hours prior to surgery (Perry et al, 2012).Depending on physicians order, patient may be on clear fluid for 1 to two days pre- procedure and enema given the previous night to permit easy insertion and clear visualisation. Checks vital signs and assess oxygen saturation level to obtain baseline and to compare post-operatively. Provide patient with gown, carefully remove patient’s dentures and artificial prosthesis patient may have an d storing them in a safe place (Perry et al, 2012). After the procedure, vital signs should be monitored closely especially temperature as sudden rise in temperature may indicate perforation, patient’s level of consciousness must be assessed to determine his ability to comprehend and follow instructions. Flatus, abdominal discomfort, fever, rectal bleeding, chills, swallowing difficulty, malaena, haematemesis are common therefore should encourage patient to report if notice any (Brown Edwards, 2012).Assess patient bowel sound and swallowing reflexes and encourage to eat and drink when present. Normally patient’s are not allowed to drive or operate machinery 24hours following procedure, therefore nurse should ensure that patient is accompanied home by an identified driver (Perry et al, 2012,). In a case of rectal bleeding, the nurse will support patient to bed to ensure comfort. Check vital signs because any significant drop in blood pressure and sudden rise in heart rate may serve as a good indicator for severe blood loss. If noticed any deviation, patient appears weak and unstable, urgent fluid replacement with 0.9% normal saline must be given to replace fluid loss. Closely monitor his abdomen for tenderness and distension. If after all these measures his condition still remains the same, medical team must be alerted for further treatments (Craft et al, 2011) Putting in place the above nursing interventions will help alleviate pain and manage post op complications in patients. Nursing care considerations always need to be specifically befitting the patient’s condition and their current presenting problem. As in the above the care consideration for a patient with musculoskeletal problems is definitely different from the other patient with gastrointestinal system diseases.

The Open Boat Essay -- Literary Analysis, Stephen Crane

â€Å"When it came night, the white waves passed to and fro in the moonlight, and the wind brought the sound of the great sea’s voice to the men on the shore, and they felt they could then be interpreters† (Crane 370). â€Å"The Open Boat,† written by Stephen Crane, describes the journey of four men stranded in a dinghy in the middle of the ocean and the hardships that had to be faced in order to survive. This story is not only a riveting story, keeping readers on the edge of their seat, but the story also makes the reader realize how precious life truly is. Sometimes people have a tendency to take life as a grain of salt and do not think about the realization that life can be taken away within the blink of an eye. As in â€Å"The Open Boat,† the crew members learned they could not survive alone, and their only option was to work together as a team. We need to have that same perspective toward our everyday life when we, or someone we see, are struggling. The Captain is a major character in the story, and his character holds the other crew members heads up keeping them motivated during times of distress. He was the captain on the original boat, but after the boat sank, he become injured and could not physically participate in keeping the dinghy afloat. In the beginning, the captain feels that he has lost his sense of direction due to not being used to letting others take charge. Without his sense of authority intact, he feels disconnected from the world, and his spirit becomes dismantled. However, since he was not able to contribute in the way he preferred, he led the way by giving specific instructions to the other characters in order to keep the dinghy afloat. Every member on the boat follows his directions. He commands very respectably. This... ...ibing two different qualities that is being used together in the same statement. In summary, â€Å"The Open Boat† is a highly intriguing story that can not only be read for pure enjoyment, but it also has a moral to the story. No matter where someone comes from in life, whether someone is the richest or the poorest person on Earth, he or she should always make sure to make it a point to look out for someone and have their back when they are struggling. By looking out for each other, just as they did in â€Å"The Open Boat,† they created strong everlasting friendships. If someone is being looked out for by someone else, then that person will make a point to return the favor as well. Life is just like the ocean. We might have our ups and our downs, but life never changes. The only thing that will affect the outcome of our lives is the perspective that we put toward our life.

Interviews Guidelines :: Interviewing

Interviews Guidelines Hi friendz today I am gonna tell you some of the questions the interviewers’ will ask you generally. Please note that these questions are for general purpose only and meant for mainly those interviews which judge the overall personality of man/woman. 1.  Ã‚  Ã‚  Ã‚  Ã‚  OK Mr./Ms. XYZ tell me something about yourself? Hint: the interviewer is going through u’r c.v. and wants some time. He may not be looking at u’r face. Just speak on continuously and don hesitate. The most important things which should be included are: Salutation; Your name; schooling; college; work experience; why u wanna join and how u’r qualification and experience would relate to the post vacant. 2.  Ã‚  Ã‚  Ã‚  Ã‚  What are your hobbies? Hint: Don’t write those hobbies in which u don’t know in detail. Suppose u tell u’r hobby as cricket but u may not show him any award won in that! 3.  Ã‚  Ã‚  Ã‚  Ã‚  Why Do you want to join this organization? How can u help us? 4.  Ã‚  Ã‚  Ã‚  Ã‚  What is u’r ambition in life? Hint: this is a remarkable question; If u r going for a marketing kind of job and tell that u r not after money but recognition first; u may not be selected; as marketing can be done only by those who r after money only as their priority as their main source of income is their commissions. 5.  Ã‚  Ã‚  Ã‚  Ã‚  What is u’r expected salary? Hint: Don’t under – estimate u’r self. U would be surprised to know that some applications are rejected only because they are ready to work for a very lesser amount ! They argue that we don take the cheap variety. Get Branded; see what is the salary generally accepted in u’r field and demand in proportion to that. 6.  Ã‚  Ã‚  Ã‚  Ã‚  Well Mr./Ms. XYZ Tell me where do u see u’r self after 2 years from now? Hint: Be Specific, Don tell u r going 2 be the BILL GATES. In 2 years. They’ll tell u that they cant’ hire a bill gates and cant’ promote u at that level within 2 years. 7.  Ã‚  Ã‚  Ã‚  Ã‚  You told that u wanna be†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. ,; what are u doing to achieve that? 8.  Ã‚  Ã‚  Ã‚  Ã‚  What are u’r strengths? 9.  Ã‚  Ã‚  Ã‚  Ã‚  What are u’r weaknesses? Hint: Be sure u r not caught; You can tell that I am emotional; etc. 10.  Ã‚  Ã‚  Ã‚  Ã‚  When did u see u’r strength as u described above helped u overcome a situation? And the weakness u had suffer from? 11.  Ã‚  Ã‚  Ã‚  Ã‚  Tell me which are u’r favourite subjects? Hint: Hey don study only one subject. Sometimes it has happened that they ask another question; And the second favorite?

Benign Paroxysmal Positional vertigo

Benign Paroxysmal Positional vertigo (BBPV) or ‘cupololithiasis’ is a common condition in which the individual experiences episodes of recurrent and brief postural vertigo and nystagmus (rhythmic rotation of the eyeballs) that tends to occur in clusters. The exact cause of the condition is not understood clearly, but the displaced remnants of the utricular otocania (which is a membranous structure present within the ear). The condition is also said to arise due to abnormalities in the posterior semicircular canal.It may be provoked by altering the position of the head relative to gravity during lying down, rolling the head in the bed, bending, titling the head backwards, sleeping or sitting up. The episodes of vertigo usually last for about 10 to 30 seconds. BPPV can involve either the posterior semicircular canals or the lateral semicircular canals or both. The condition can occur on one side or on either side of the skull. A Posterior canal BPPV can be converted into a lateral BPPV following repositioning maneuvers. The episodes of vertigo may take a few months or even years to resolve.The remission and recurrence is often considered to be unpredictable. BPPV is one of the most common disorders in which vertigo is experienced. The incidences may be about 17 % when a study was conducted in a vertigo clinic. In Japan, the occurrence of BPPV is about 10. 7 to 17. 3 per 100000 new cases every year. However, the actual incidence rates may be much higher as the condition can spontaneously resolve. The condition occurs more often in females compared to males. However, in younger individuals who often develop the condition following trauma, the male to female ratio is almost equal.The condition more frequently occurs in middle aged and elderly individuals between the ages of 40 to 65 years. In a study conducted in the elderly population, it was observed that about 10 % had unrecognized BPPV. Today, BPPV is one of those conditions which can be promptly di agnosed using a specific diagnosis process and treated using advanced techniques. Physiology A lot of studies have been conducted to determine the exact mechanism by which BPPV. In the inner ear, a small organ known as ‘vestibular labyrinth’ is present. Within this, a small structure known as ‘semi-circular canals’ is present.The semi-circular canals are nothing but loop-like structures, containing fluid and hair-like projections. They help to determine the movements of head in a three-dimensional direction. The Otolith also helps to determine the movement of the head relative to the body. In the otolith, certain crysltals of calcium carbonate are present. In certain conditions, these crystals may get dislodged into the semi-circular canals. When these crystals get dislodged, it makes the head very sensitive to positional changes. In conditions it is normally not required to respond, a dizziness-like sensation is perceived.BPPV are of two types, primary or idiopathic and secondary. In primary BPPV, the cause is not known and it accounts for 50 to 70 % of the cases. Secondary BPPV account for 7 to 17 % of the cases and is usually associated with head trauma. When the head is traumatized, otoconia crystals are released into the endolymph. The otoconia crystals are actually calcium carbonate crystals that get embedded in the utricle and the saccule. This occurs bilaterally, resulting in BPPV occurring on both sides. Studies have demonstrated that in 0. 5 to 3. 1 % cases, BPPV is associated with Meniere’s disease.Recently, it has been found that migraine is also closely associated with BPPV. Studies conducted on patients suffering from migraine when the patients were positioned in certain postures, BPPV tended to occur. The exact mechanism between migraine and BPPV is not known, but it is supposed to occur due to spasm of the inner ear. BPPV may also occur following surgery of the inner ear. Once the otoconia crystals get displaced , they begin to stimulate the hair cells present in the posterior semicircular canals. Once this promotion occurs, the individual constantly feels that he/she is in motion.There may also be other etiological factors for BPPV including degeneration of the otoconia membranes, concussion of the labyrinthine, middle ear infection, viral infections of the ear (such as viral neuronitis), taking bed rest for long periods of time (lying supine for long time), blockage of the anterior vestibular artery, anesthesia administration, administration of certain drugs, etc. Symptoms The symptoms of BPPV usually occur following a period of latency during which the condition initiates, but the symptoms are not felt.An individual suffering from BPPV would develop several symptoms including brief attacks of horizontal and/or vertical vertigo, dizziness, light-headedness, unsteadiness, a sense of loss of balance, blurring of vision which develops in association with the vertigo, nausea vomiting, etc. th e vertigo is usually felt following rolling on the bed or extending the head backwards. The individual may develop the vertigo when moving the head towards the left or the right or both. Whichever side the vertigo develops, that particular side is involved in the vertigo process. The attacks of vertigo usually last for about half a minute or thirty seconds.On repeated testing of vertigo symptoms, it usually diminishes. In some patients, this duration may get extended for about one minute. About 50 % of the patients suffering from BPPV experienced a kind of floating sensation. Following he vertigo sensations, the individual also experiences bouts of nausea and loss of static equilibrium. The frequency of the vertigo attacks vary from one individual to another, ranging from a several episodes in a day to a few episodes in a week or month. Some individuals may also be sensitive to movement of the head in any direction.Along with the symptoms, the individuals may also develop several me ntal symptoms including anxiety, depression, cancer phobia, etc. In certain situations, the vertigo attacks may be life-threatening. Take for example a high-rise building construction worker, can put himself in danger of losing his life in case he develops a vertigo attack related to BPPV. Even driving whilst suffering from BPPV is a danger, as the visual field is impaired. The episodes of vertigo can in fact disappear during the course of the disease and suddenly recur. Abnormal eye movements (nystagmus) are also common in BPPV.Serious complications arising from BPPV are rare. One of the potential complications includes dehydration due to constant vomiting which may develop from vertigo. Tinnitus and hearing loss are rarely associated with BPPV. Diagnosis The diagnosis of BPPV is made based on the history, symptoms, signs, physical examinations and diagnostic tests such as your electronystagmography (ENG), videonystagmography (VNG) and Magnetic resonance scans (MRIs). One of the co mmonest signs of BPPV is dizziness that occurs when the head or the eye is moved, that tends to occur for duration of up to one minute.One of the diagnostic examination procedures utilized to determine BPPV is Dix-Hallpike maneuver. It is utilized especially to diagnose posterior BPPV. The patient is made to sit upright on the bed with the chin/head facing downwards. Then the patient is slowly moved backwards and is taken into a lying position on the bed, with the chin/head moved backwards. Once the patient is taken into this position, nystagmus develops after one to five seconds and lasts for about 30 seconds. The nystagmus has initially a light vertical component and then a strong torsion component.When the patient is moved from the lying with head facing backwards, to the sitting position with the head bend downwards, then the two components of the nystagmus also beings to appear in reverse order. An associated sign with the nystagmus is vertigo which varies depending on the inte nsity of the nystagmus. The procedure should be repeated with the head facing the right side and the left side to determine the involvement of the posterior canal on either side. In order to determine for lateral BPPV, the patient is made to lie supine on the bed with head upright.Then the head and the entire body are turned to the suspected side of involvement quickly. A nystagmus appears which is horizontal in nature which has very short latency periods and becomes more and more oblivious when the test posture is maintained. The individual may get fatigued when kept in the lateral position for a long time. In some patients, the Dix-Hallpike maneuver may be positive, but may not in fact experience the symptoms of vertigo. These patients need to be tested again by repositioning. Electronystagmography and videonystagmography is utilized to determine the abnormal eye movements.ENG is enabled by using electrodes whereas VNG is enabled using cameras. The individual may feel dizziness du ring certain maneuvers, and this is studied using ENG and VNG. MRI scans are basically done to determine any brain tumor or lesion present within the skull that could be causing dizziness and vertigo. Gadolinium-enhanced MRI scans can help to determine of any lesion within the skull more closely. Several other conditions such as labyrinthitis, vestibular neuronitis, Meniere’s disease, etc, need to be ruled out through the process of differential diagnosis. TreatmentBPPV can remit spontaneously within a few months or weeks without any treatment. Drug treatment is usually not recommended, as the symptoms can reduce only temporarily and it offers no permanent solution for the condition. In some individual, the adverse affects of certain drugs may worsen the vertigo. One measure that can be applied in order to treat vertigo is exercises or provocative maneuvers. The individual needs to perform certain exercises in the morning which would cause fatigue and ensure that the symptoms for the remaining portion of the day are within control.Surgery and the canalith repositioning procedure (CRP) seem to the most effective forms of treatment for the condition BPPV. In the CRP procedure, the physician or the audiologist would be performing a series of maneuvers in order to reposition the canalith into the utricle. In the Epley’s maneuver, the patient is sedated and mechanical skill vibration is utilized to move the head into 5 different positions. The otolith debris would then be influenced by gravity and would move from their position in the semicircular canals into the utricle. The particle repositioning procedure is done by using a 3 stage maneuver.The physician or the audiologist should have a clear understanding of ear anatomy and the mechanism in which BPPV occurs. The prolonged position maneuver is utilized to treat BPPV that arises due to involvement of the lateral canals. Studies conducted by Blakley (1994) demonstrated that there were no significant changes in the outcome when the patient was treated with CRP or with nothing. This is because the brain may adapt to the vertigo. Surgery is usually recommended if the BPPV does not respond to maneuvers nor has a multiple recurrence rates.Singular neurectomy involves sectioning the ampullary nerve that transmits nerve signals from the posterior semicircular canals to the brain. However, there are also chances that the patient could become deaf. Posterior semicircular canal occlusion involves causing blockage of the semicircular canal lumen in order to prevent endolymph from flowing. When the individual performs any movement, the cupula does not respond. References: Epley, J. M. (1992). â€Å"The Canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo. † Otolaryngology – Head and Neck Surgery, 107(3).Gordon, C. R. Et al (2004). â€Å"Repeated vs single physical maneuver in benign paroxysmal positional vertigo. † Acta Neurol Scand, 110, 166–169. Mayo Clinic Staff (2008). Benign paroxysmal positional vertigo (BPPV) – Introduction, Retrieved on June 3, 2008, from Mayo Clinic Web site: http://www. mayoclinic. com/health/vertigo/DS00534/DSECTION=1 Oghalai, J. S. (2007). Benign Paroxysmal Positional Vertigo, Retrieved on June 3, 2008, from The Merck Manual Web site: http://www. merck. com/mmpe/sec08/ch086/ch086c. html# Parnes, L. S. , Agarwal, S. K. , & Atlas, J. (2003).â€Å"Diagnosis and management of benign paroxysmal positional vertigo (BPPV). † CMAJ, 169(7). Nunez, R. A. Et al (2000). â€Å"Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. † Otolaryngology–Head and Neck Surgery, 122(5). Seo, T. Et al (2007). â€Å"Immediate Efficacy of the Canalith Repositioning Procedure for the Treatment of Benign Paroxysmal Positional Vertigo. † Otology & Neurotology, 28: 917Y919. Woodsworth, B. A. , Gillespie, M. B. , & Lambert, P. R . (2004). â€Å"The Canalith Repositioning Procedure for Benign Positional Vertigo: A Meta-Analysis. † Laryngoscope, 114, 1143–1146.

Course notes Operations management

A lot of things we do, activities such as analyzing, does not add value. Inventory Is a big non-value added activity, If you have two Items (toasters) where one has been there for long and the other Is fairly new. As a customer you want the new one. As a manager for the store, the old one costs more because you have to store it. Exercise: What is the input, what is the transformation and finally the output? Accountants: the transformation Is they are doing audits, financial statements etc.The Input Is raw data and the output is audited financial statements. Telecommunication companies: the transformation Is transmission of data, the Input is data and the output is data as well. System example: Restaurant Objectives: make money essentially, fast food or exclusive? Elements: tables, servers, waiters, wine experts, chefs etc. Input: customers Transformation: you feed the customers In an environment they find agreeable. Output: satisfied customers Feedback: Are we making money? They also use Customer satisfaction services.Restaurant Political, Legal: permits, alcohol permits, hourly wages, is tips Included? Economical: Price of food, price of dollar. Social: what type of food people eat. Technological: systems to communicate with the kitchen, ordering or reservations through internet. Ecological: recycling. Example: Strategic, tactical and operational decisions. Strategic: what type of cuisine? The limit, how many tables for which demand? Tactical decision: what type of employees should I recruit? Operational decisions:

Animals and Myriad Ways they can Kill or Heal Us Essay - 1

Animals and Myriad Ways they can Kill or Heal Us - Essay Example Introduction A lot of animals in this world are poisonous. Often they come in direct conflict with humans and become the cause of death and partial or total paralysis. This is the reason man has hated these animals for centuries. By making these animals useful, present advancement of science and technologies has changed this preconceived notion. Some of these animals are snakes, spiders, and scorpions. This paper reviews the benefits that are derived from venoms of these animals, the process of processing venom and the diseases they cure. Venom ejected by snakes can be broadly classified into four groups. These are neurotoxins, sitotoxins, hemotoxins and miotoxins. In the majority of cases, neurotoxic venom is related to the nervous system, hemotoxins is related to blood and vascular tissues and miotoxins is a combination of both neurotoxic and hemotoxic venoms. Cobra is one of those snakes whose venom is used for therapeutic purposes. Venom ejected by cobra can be classified as a ne urotoxin, a compound that affects nervous systems of human beings. Reference to cobra venom can be traced to Chinese civilization and Vedas. During the early 1900’s cobra venom was largely used as a medicine to treat people with depression, back pain, headaches and menstrual pain (The Therapeutic Uses of Cobras’ Venom Neurotoxins, n.d.). ... The homeopathic physicians prescribe venom of Asian Cobra (Naja tripudians), but in practice, venom from all types of cobra from Middle East to Philippines is taken and processed (The Therapeutic Uses, n.d.). Medical use Since 1960, snakes venom has acquired an important place in medical treatment. The compounds present in snake venom affect muscle contraction by enhancement of the hormone Bradykinin. This hormone is responsible for dilatation the blood vessels. â€Å"The peptides present in venom transform angiotensin I into another peptide, angiotensin II, which also supports constriction†. When the Bradykinin as well as other peptides are blocked, the process of ‘blood vessel constriction’ no longer functions. Only the process of dilatation takes place. This makes snake venom an effective and alternative treatment for treating symptoms of hypertension. In spite of not being a medical drug, peptide present in snake venom contains numerous chemical features which make â€Å"it indispensible for heart attacks, neurological disorders, diseases related to blood†. Some drugs that are processed from venom of snakes are Lisinopril, Enalapril, Defibrase and Captopril. More extensive use of snake venom is utilized in treating problems related with blood cells. Snake venom has also helped in development of non- peptide compounds like Aggrastat by using ‘disintegrin’, which is a toxin present in the venoms of saw- scaled viper found in Africa. The compound functions by binding fibrinogen receptors present in blood onto platelets which is performed by disintegrin, thus performing the function of a coagulant. Some compounds in snake venom, like ‘Ancrod’ enzyme of Calloselasma rhodostoma also functions as

GP210 week 2 Research Paper Example | Topics and Well Written Essays - 250 words

GP210 week 2 - Research Paper Example nalist views argue that a constitution does not evolve or change; therefore, it will always mean what it meant when it was adopted in a country (Exploring Constitutional Conflicts, 2012). With this view in mind, its interpretation must be in line with the thoughts that the people who came with it had in mind. These people also argue that originalism preserves the authority of the court which is a mandatory element in ensuring that there is the prevalence of justice in a country. Thus, this school of thought believes that the constitution must be interpreted with regard to the views of the original composers. On the other hand, those who oppose this viewpoint argue that no written constitution can anticipate the means that the government might use to oppress people; hence it is sometimes mandatory for judges to fill in the gaps that exist in the constitution through their interpretation (Exploring Constitutional Conflicts, 2012). With these view in mind, the constitution must be interpreted with the needs of the people it is supposed to govern in mind. In addition to this, non-originalism allows judges to rectify inflexible interpretations that no longer serve their original purposes (Whittington, 2001). The need to amend or possibly revoke bad laws that exist in the constitution will be realized with continual originalist interpretations. Other than leave courts to continuously find fault in the constitutional provisions, the people concerned will be obliged to come up with a new constitution that best suits the needs of people. However, coming up with a new constitution is a costly affair and this is the reason why non-original interpretations should be given way. Moreover, they will allow for more enlightened understanding on contemporary issues such as equal treatment of blacks, women and other minority groups (Whittington, 2001). With these views in place, it is clear that non-originalist interpretations of the constitution are more favorable. Apart from