William Wordsworth Essay -- essays research papers

William Wordsworth William Wordsworth was, in my eyes one of the best know romanticist writers of his time. Most of his pieces talk about nature and religion. He, like most romantic poets of his time revolted against the industrial revolution and wrote many pieces about nature in order to go up against it. During the industrial revolution there were many factories being built up that took away most of the open countryside that everyone enjoyed. In these factories, workers were given long hours and little pay for their harsh working conditions. Wordsworth saw this and was appalled at how the factories could first come and take over the land and hire workers for practically no pay and long hours, so he wrote about nature to rebel against the factories. He wrote these poems to let people escape the reality of their lives and have something that was positive to live for. Wordsworth is considered a romantic because his writings were very imaginative, emotional, and visionary. He regularly discussed poetry with his friend Samuel Coleridge, who at the time was also a romantic writer. In their time as friends they wrote and discussed many poems, which later led to the writing of a prelude for his wife whom he had four children with. Originally Wordsworth was from England and was born in 1770 and graduated from Cambridge University. After he graduated he began his work on the idiom of the eighteenth century, which rebelled against the industrial revolution. Dorothy Wordsworth, Wi...

Leading and Managing Change :: Organizational Development, Planned Change

Organisational development is both a professional field of social action and an area of scientific inquiry†. (Cummings and Worley, 2009, p.1). Organisational development does not have common definition; however, it has more than one definition that expresses the meaning of organisational development and change. Organisational development can be best described as a â€Å"system wide process of data collection, diagnosis, action planning, intervention, and evaluation aimed at enhancing congruence among organisational structure, process, strategy, people, and culture; developing new and creative organisational solution; and developing the organisation’s self-renewing capacity.† (Beer as cited in Cummings and Worley, 2009, p.2). It occurs through the cooperation of organisational members working with a change agent using behavioural science theory, research, and technology (Beer as cited in Cummings and Worley, 2009, p.2). Organisational development and change managem ent deal with the effective implementation of planned change (Cummings and Worley, 2009, p.3). The two terms deal with the leadership issues and the change process (Cummings and Worley, 2009, p.3). Change is very critical process for every organisation and it is a characteristic of organisational development. Change is moving from one state to another; it is the inevitable aspect of life and the essence of any organisation (sharma,2007,p.1);it is the only constant and is moving target as change pace became so rapid so it needs effective management and leadership to be successfully implemented (Cummings and Worley, 2009, p.27). Change Management: Management and change are interrelated. It is impossible to undertake a journey without addressing its purpose (Paton and Mccalman, 2008, p.3). â€Å"Managing change is about handling the complexities of change; it is about evaluating, planning, and implementing operational tactics and strategies† (Paton and Mccalman, 2008, p.3). According to Armenikas and Bedeian organisational change is greatly responsive to management; its possibility remains high as managers strive for successful and perfect change in the organisation (Paton and Mccalman, 2008, p.3). Change management is a complex, and dynamic process; it is about finding best fit for the organisation to get best results (Paton and Mccalman, 2008, p.4). The environment is rapidly changing resulting from changes in technologies, customers’ preferences, alteration in the economy and many other factors (Paton and Mccalman, 2008, p.10) so organisations have to take the journey of change to cope with the external forces facing them and that is done through management. In order to be able to manage change effectively, managers have to look to the faults and problems found in the organisation, putting alternatives and stating its pros and cons, decide on the future state of the organisation and then implement the change process (Paton and Mccalman,2008,p.

Investigating the Properties of Ph

Investigating the Properties of pH The manufacture’s claim is that Sensodyne toothpaste micro hardens tooth enamel to help protect against the effects of acid wear, helps stop the twinges of pain from sensitive teeth formulated with low abrasivity, neutral pH and gentle yet effective cleaning system. To find out if the manufactures claim on Sensodyne toothpaste is the correct level of pH. I expect the Sensodyne toothpaste to be a neutral pH level as the manufactures claim that this products pH level is neutral. This would be indicated by a level of pH 6 and 7. The equipment needed for this practical * Sensodyne (toothpaste) Universal indicator * Universal paper * pH meter * Petri dish x 3 * Measuring cylinder x 6 * Wooden stick * Distilled water * Tap water * Ruler Method 1. Test the distilled water and tap water for the pH level to see if it were neutral so it wouldn’t make a difference to the results. 2. Set up 3 petri dishes and 3 measuring cylinders 3. Measure 10mls of tap water. Add water to the petri dish and add 5cm of Sensodyne (toothpaste) into each petri dish and repeat this step 3 times. 4. Measure 10mls of distilled water and add to the measuring cylinders as well as adding 5cm of Sensodyne (toothpaste) and repeat this step 3 times. . Mix the substances together with the wooden stick. 6. Put universal indicator (liquid) into the petri dish repeat this step 3 times. Record the results from each petri dish. 7. Put universal indicator (paper) into the measuring cylinder repeat this step 3 times Record the results from each measuring cylinder. 8. Set up pH meter, Put the pH meter into the measuring cylinder record the pH reading and repeat this step 3 times for a reliable. Results Table Universal Indicator Universal Paper pH Meter Test 1 pH6 6 7. 0 Test 2 pH6 6 6. 99 Test 3 pH6 6 7. 09 Photographic evidence of experiments Before: After: Before: After: Discussion * The results show pH of the toothpaste is neutral according to the pH meter, and slightly acidic according to the paper and indicator. The pH was discovered to be between 6 and 7 in all the tests done * The manufacturers’ claim was the pH level of the sensodyne (toothpaste) was neutral. My hypothesis was that the toothpaste was pH neutral and this was supported by the results. * I compared distilled water and tap water because of the different chemicals mixed with the water, but the results showed no difference so it didn’t affect the pH. The pH meter showed little varying but not too much this could be that the pH meter is out or that there could be something wrong with the meter because with my supported evidence its unlikely to be wrong. To improve this experiment would be to test with more than one pH meter to see if there’s a difference in comparison. Otherwise it may be more efficient if there were more tests done for more support towards the result. * My independent variable is the sensodyne (toothpaste) because in every experiment I used the same amount of sensodyne. The dependant variable was the pH levels were I did not have control over what the pH level would indicate. This is the reason the results are reliable because I repeated the steps three times in each test and continued to get the same results. This experiment could be improved by obtaining samples of toothpaste from a variety of locations. This will identify and inconsistency’s in the product itself. Conclusion * The experiment found that the manufactures claim of pH is correct and it is a neutral pH with supported evidence. Teeth would be affected by acidic toothpaste or alkaline toothpaste. Therefore a pH between 6 and 7 is an appropriate toothpaste . This sensodyne (toothpaste) is designed to help people with sensitive teeth.

Case Study: Osteoarthritis with a Total Knee Arthroplasty Essay

DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future due to his active lifestyle as a dairy farmer. DN is presently in very good health despite his pain from osteoarthritis. Osteoarthritis is caused from wear and tear on the joints. The bones between a joint is cushioned by cartilage which after many years of use decreases. When the bones no longer have the cushion, pain and stiffness develops when the bones rub together (Total Knee Replacement, 2009). His health history includes overcoming prostate cancer approximately six years ago. After a prostatectomy to remove his cancer, DN continues to experience erectile dysfunction even after seeing many specialists and trying many treatment options. In 1999, DN had his appendix removed at Ozark Medical Center. DN has a herniorrhaphy and cataract surgery prior to this hospitalization. DN has no known allergies to drugs, food, or environmental allergens. The patient lives at home with his wife on a dairy farm. He handles about 170 head of dairy cattle that are milked twice a day. He retired from Howell-Oregon County Electrical approximately five years ago to help manage his farm on a full time basis. DN and his wife raised three children and have several grandchildren who come and visit frequently. DN does not have any significant history of nicotine, alcohol, or drug use. His diet has consisted of fresh fruits and vegetables from the garden throughout his life. These factors have all played a part in helping DN stay healthy without any underlying chronic disease processe s. Physical Assessment My physical assessment was performed on September 16, 2009. DN’s vital signs consisted of an apical pulse of 98, a respiration rate of 20, a temperature of 99.1 degrees Fahrenheit, an oxygen saturation of 96%, a lying blood pressure of 117/78, a sitting blood pressure of 116/75, and a standing blood pressure of 116/74. Patient was alert and oriented to person, place, time, and situation. Patient was able to spell WORLD forward and backwards. PERLA and noted cardinal field of gaze were intact. Eyes were clear with conjunctiva pink and no discharge noted. Patient’s head and face was symmetrical with no apparent skin breakdown. Patient had dentures intact in mouth with healthy, pink gums with no lesions present inside the mouth. Thorax was symmetrical with no signs of pulsations or lesions. Breath sounds clear in all lobes. Unlabored breaths. Heart sounds S1, S2 were heard upon auscultation in all four cardiac areas with normal rhythm. Abdomen is soft, symmetrical with hyp oactive bowel sounds present in all four quadrants. Last bowel movement was on Sunday, September 13. Patient was passing flatus. No masses, distention, or lesions noted on the abdomen. No tenderness was noted in the abdomen. No edema was noted in the upper or lower extremities. Upper and lower extremities had no sign of lesions or discoloration. Saline locked on left forearm was intact with no redness or swelling. Surgical incision on lower left extremity had scant amounts of serosanguineous drainage, wound edges were well-approximated, slight erythemateous around incision, no odor present, and dressing was dry and intact. Pulses were strong and equal bilaterally- including carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibialis. Skin was warm and pink with no signs of cyanosis, rash, or skin breakdown. Gait was symmetrical and coordinated when using a walker, without the supportive device there is some unsteadiness due to the left total knee arthroplasty. There was no hearing deficit noted with normal conversation. Patient only had complaints of pain at surgical site after ambula tion, physical therapy or the CPM. Patient was taught he could ask for the pain medicine prior to these events to hopefully avoid intense pain. Current Medications Throughout DN’s hospital stay he was prescribed medicine to alleviate the pain caused from the total knee arthroplasty, help prevent any infection that had potential to be a problem, and prevent any complications. DN’s urrent medications while in the hospital were as follows: 1.) Docusate-Senna (Trade Name: Peri-Colace) 1 tablet by mouth, twice a day; used for softening and passage of stool for the relief of constipation caused by post operative anesthesia and decreased activity (Deglin & Vallerand, 2007). 2.) Enoxaparin (Trade Name: Lovenox) 40 mg by subcutaneous injection, once every morning; used for the prevention of thrombosis formation (Deglin & Vallerand, 2007). 3.) Psyllium (Trade Name: Metamucil) 1 tablespoon by mouth, twice a day; used for relief and prevention of constipation (Deglin & Vallerand, 2007). 4.) Acetaminophen-Oxycodone (Trade Name: Percocet 5/325) 1-2 tablets by mouth, every four hours; used for decreasing pain as well as decreasing a temperature (Deglin & Vallerand, 2007). 5.) Magnesium Hydroxide (Trade Name: Milk of Magnesia) 30 mL by mouth as needed; used for replacement in a deficient state or evacuation of the colon (Deglin & Vallerand, 2007). 6.) Morphine (Trade Name: Astramorph) 8 mg by intravenous piggyback, every three hours as needed; used for a decrease in the severity of pain (Deglin & Vallerand, 2007). 7.) Promethazine (Trade Name: Phenergan) 12.5 mg by intravenous piggyback, every four hours as needed; used for diminishing nausea and vomiting, as well as provide some sedation (Deglin & Vallerand, 2007). Diagnostic Tests DN had diagnostic tests prior to being admitted to the hospital for his total knee arthroplasty to determine the best treatment option for his osteoarthritis. After his surgery, more diagnostic tests were done to monitor for complications of the procedure. The results were compared to normal and were as follows for the patient: 1.) White Blood Cells (Normal Value: 5,000-10,000/mm3) Patient’s white blood cell count was 12,800/mm3, which is a high value. This value indicates the stress on the body and inflammation around the knee involved after the operation. The value is also a possible indicator of infection, which would require continued monitoring (Pagana & Pagana, 2006). 2.) Red Blood Cell Count (Normal Value: 4.7-6.1Ãâ€"106/ µl) Patient’s red blood cell count was 3.74Ãâ€"106/ µl, which is a low value. This value indicates the blood lost during surgery, which is a common finding after an invasive surgery. A decreased level may indicate a hemorrhage, overhydration, or a dietary deficiency, which may need to be corrected (Pagana & Pagana, 2006). 3.) Hemoglobin (Normal Value: 14-18 g/dL) Patient’s hemoglobin was 11.8 g/dL, which is a low value. This value is a common finding after surgery due to the blood loss, but the value may also indicate anemia or nutritional deficiency (Pagana & Pagana, 2006). 4.) Hematocrit (Normal Value: 42-52%) Patient’s hematocrit was 34.4%, which is a low value. This is a normal finding after surgery, but may indicate anemia, malnutrition, or a dietary deficiency that may need to be corrected (Pagana & Pagana, 2006). 5.) Mean Corpuscular Hemoglobin (Normal Value: 27-31 pg) Patient’s mean corpuscular hemoglobin was 31.8 pg, which is just slightly elevated. This value could possibly indicate a macrocytic anemia, but is not elevated enough to be a significant concern (Pagana & Pagana, 2006). Basic Conditioning Factors and Power Components Dorthea Orem identifies ten basic conditioning factors that identify the patient and help assess the need for care in her Self-Care Deficit Theory of Nursing. The basic conditioning factors identified by Orem consist of age, gender, Erikson’s developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and availability of resources (Caton, 2008). DN is a 68 year old Caucasian male who lives in Pomona, Missouri where he and his wife own a house. DN grew up in Dora, Missouri where he graduated high school, then relocated to Pomona at the age of nineteen. DN has three grown children and several grandchildren. DN’s family remains very close and visit often to where DN lives. DN quit his job at Howell-Oregon Electric in 1980 to become a full time farmer. DN and his wife own approximately 300 acres to operate a dairy and beef cattle farm with 170 head of cattle. They milk the cows twice a day keeping them very active throughout the day. DN considers himself to be in the middle-class economically, but with the unpredictable cattle market economic status can change throughout the year. DN has Medicare as primary insurance with supplements. Before his admission to the hospital, DN’s health state was good. DN’s health care system factors consist of a medical diagnosis of osteoarthritis. The treatment of choice for DN was a left total knee replacement. After discharge, home health will help organize physical therapy closer to home. DN does not have any underlying diseases, such as hypertension or diabetes, which can cause complications or alter the ability of DN to have a speedy recovery. He has a primary physician in Willow Springs for yearly check-ups and minor problems. DN’s patterns of living include hunting and fishing, going to church, and taking care of the farm. DN does not smoke or drink alcohol. According to Erikson, he is in a developmental stage of ego integrity versus despair (Berman et al., 2007). DN belongs in this psychosocial developmental stage because he is at a stage where he is content with his life and satisfied with everything that has happened in his life thus far. He is able to reflect on his past without regret. DN feels as if he has lived a life full of happiness. Orem identifies ten power components that are important in evaluating how much nursing care is needed by the patient. The ten power components consist of attention span and vigilance, control of physical energy, control of body movements, ability to reason, motivation for action, decision making skills, knowledge, repertoire of skills, ability to order self-care actions, and ability to integrate self-care actions into patterns of living (Caton, 2008). DN’s attention span ad vigilance is a strength because throughout the physical assessment and health history, he remained very attentive and honest when answering the questions. His control of physical energy is a potential weakness due to the fatigue DN could experience after his knee replacement. After surgery, becoming fatigued is easier due to the pain and inability to get a good night’s rest in the hospital. DN seemed to know his limits with what kind of physical energy he had to use throughout his stay. The patient’s control of body movements is a strength. Even though DN is recovering from a total knee replacement, he maintains good control over his movements. He also has a steady gait when walking with a supportive device. The patient’s ability to reason is a strength. When he needed help, he knew to ask his wife, a nurse, or an aide for help. He understood that Home Health would be a benefit once he was discharged from the hospital. Motivation for action is definitely a strength. DN was very motivated to get back on his feet as soon as he could. He knew physical therapy was what would help the most so he was always ready to go when physical therapy came to take him to the Joint Club. After returning after a trip to physical therapy, the patient stated, â€Å"The physical therapist said I did better than all of the other patients with knee replacements.† The patient’s decision making skills were strength because he took all options into consideration prior to getting his knee replacement. He knew it would be the best option with the active lifestyle that he has. Knowledge was a potential deficit for the patient because he had never had a knee replacement surgery before. The patient was informed of all the procedures, hospital stay, and expected outcomes during consultation appointments, but all the information at once can be overwhelming for the patient. Even after the surgery, the patient still questioned the health care team members throughout the hospital stay to refresh his memory. Repertoire of skills is a strength because the patient has a high school education, as well as the same occupation throughout his life. He is able to retain information and repeat skills if needed. DN’s ability to order self-care actions is a strength because he is able to decide what actions are most important and follow through with them. He decided to have his knee surgery to benefit his lifestyle and made it a priority to get it done as soon as he could. The ability to integrate self-care actions into his patterns of living is a strength for DN. He integrates a healthy diet and active lifestyle to prevent complications of his osteoarthritis. After trying minor treatment options to control pain and discomfort from the osteoarthritis, DN opted for surgical treatment and he realizes the physical therapy he will have to integrate into his lifestyle for full recovery. Universal Self-Care Requisites Orem’s General Theory of Nursing involves self-care, self-care deficit, and nursing systems. Orem’s definition of self-care is what people plan and do on their own behalf to maintain life, health, and wellness. The nursing systems that Orem identifies are wholly compensatory, partly compensatory, and supportive-educative. The universal self-care requisites that patient may be deficient, potentially deficient, or a strength in consists of air, water, food, elimination, activity and rest, solitude and social interaction, prevention of hazards to human life, and normalcy (Berman et al., 2007). Air: Potential Deficit Air is a potential deficit for this patient. Upon assessment, his respiratory rate was within normal range at 20 breaths per minute. Normal respirations for the age group of the client range from fifteen to twenty per minute (Berman et al., 2007). The patient has a stable respiration rate between this level, but with decrease red blood cells, hemoglobin, and hematocrit the patient’s oxygen level may increase to compensate for the lack of cells that can carry the oxygen, especially during physical therapy. DN’s lung sounds when auscultated were clear in all lobes, bilaterally. A critical side effect of morphine, one of the medications DN was taking while in the hospital, is respiratory depression, which can happen in a matter of minutes causing a deficit (Deglin & Vallerand, 2007). Water: Strength Water is a strength for DN. No edema was noted upon assessment. Good skin turgor was indicative that there was adequate hydration for the patient. DN’s average intake was 2000 mL of fluids, usually water and ice tea. This was within normal range with the requirements being set at a minimum of 1500 mL of fluids daily (Berman et al., 2007). Food: Strength Food is a strength for the patient. The patient was on a regular diet and had no trouble eating. On some occasions, his wife brought meals to the patient. DN consumes a healthy diet, full of fruits and vegetables from his own garden when home. Protein consumed in his diet usually consists of very lean beef from home grown cattle. DN consumed enough calories to aid in recovery of his surgery. Elimination: Deficit Elimination is a problem for the patient. He has not had a bowel movement since the day before he had the surgery. DN had an epidural anesthesia until the first day post-op and is taking narcotic analgesics for pain control, which both contributed to the impaired elimination. The side effects from the medication cause the intestines to decrease peristalsis. Monitoring bowel functions, as well as administer the stool softeners and laxatives that are ordered, are two important nursing interventions (Lemone & Burke, 2008). Activity and Rest: Deficit The patient had a deficit in both activity and rest. The patient stated he was not getting adequate rest in the hospital due to the different environment and the pain he was experiencing from his surgery. In the hospital, the patient was also put on activity restrictions due to his total knee arthroplasty. He was able to go to physical therapy three times a day, but normal activities were limited for DN. At home DN does not have activity or rest deficit, he participates in an active lifestyle with lots of walking and daily physical labor. He also gets approximately 7 or 8 hours of sleep a night which is adequate for a man his age (Berman et al., 2007). Solitude and Social Interaction: Potential Deficit The patient did not have a deficit with social interaction. His wife was in the room majority of the time and he also had many people drop in and see him throughout his hospital stay. DN also interacted with people on the health care team, whether it was the nurses or physical therapists, he was always having a conversation with someone. Due the many visitors and activities DN had during the day, solitude was a potential deficit. The physical therapists and nurses that came in the room consistently make it difficult for the patient to get any time to rest and relax by himself. Adequate rest is easier to obtain when there are no interruptions in the rest period and some solitude is allowed. Hazard Prevention: Deficit Hazard prevention is a deficit for DN. The total knee arthroplasty causes the patient to be at an increased risk for infection due to all the invasive procedures done. Prophylactic antibiotics were being considered to help prevent any infection that may develop. The patient is also at risk for falls. The intravenous line and pole make it difficult for the patient to ambulate on his own while dealing with his surgery. The medications DN were taking could cause confusion, dizziness, and sedation which could lead to a fall. The patient is also at risk for a deep vein thrombus due to the surgery, which could be a fatal complication if not prevented. Compression stockings and devices were used to decrease the chance of venous stasis. Promotion of Normality: Deficit Promotion of normality is a deficit for the patient. He has only been hospitalized two other times in his life and feels uncomfortable. Since DN is not used to being in the hospital, he is hesitant to ask for pain medication until the pain is already present. Teaching DN to ask for the pain medicine prior to activities and when he recognizes the pain coming back. DN’s normal routine at home will be changed to accommodate for the knee surgery he underwent. He will have to adjust to the limitations on his activities until he is fully recovered. For example, he will have to depend on his wife and other family members to help milk the cows and take care of the farm until he has full range of movement so he does not damage his newly replaced knee. Developmental Self-Care Requisites Developmental self-care requisites are associated with conditions that result in maturation (Berman et al., 2007). DN has lived a long, productive life and many life changing events have occurred throughout his life. He graduated high school and worked multiple jobs which gave him the experience he needed to now be a self-employed farmer. He and his wife raised a family with three children, and now have several grandchildren. All of these different aspects in DN life have helped DN mature, which puts him in a developmental stage of ego integrity versus despair. According to Erikson, people in this stage should have acceptance of their life and self-worth (Berman et al., 2007). DN seems very satisfied with everything that has happened in his life. He is able to reminisce about the things that have happened in his life with a smile. He does not have any regrets about his life. At this point in DN’s life, he is always thinking of others and enjoying the small things in life. Even though DN is in this developmental stage, he has not fully completed this stage. DN is in a position where he still works and provides for his family. He is not ready to leave his family at this point in his life. Health Deviation Self-Care Requisites According to Orem, there are six health deviation self-care requisites. The health care deviation self-care requisites consist of seeking and securing medical help when needed, responsibly attending to the effects and results of pathologic conditions, effectively carrying out prescribed interventions, responsibly attending to the regulation of effects resulting from prescribed interventions, accepting the fact that sometimes self or others need medical help when faced with certain life challenges, and learning to live productively with the effects of pathologic conditions and treatments while promoting continued personal development (Caton, 2007). The patient is strong in seeking and securing medical help when needed. As soon as the patient realized his pain was increasing in his knee, he scheduled an appointment with his family doctor who referred him to Dr. Know the orthopedic surgeon. The patient is also responsible in attending to the effects and results of pathologic conditions. The patient is aware of the physical therapy regime he needs to complete for full recovery, as well as the preventive measures he needs to take to protect his right knee. The third health deviation self-care requisite is to effectively carry out prescribed interventions, which is a strength for the patient. DN realizes he will continue with physical therapy after discharge on the hospital and will be on a few prescription medications. Other interventions, such as wearing TED hoses, limiting activities, and allowing home health to help with his care, will all be followed by the patient. The fourth health deviation self-care requisite is to responsibly attend to the regulation of effects resulting from prescribed interventions is a potential deficit. Even though the patient stated he will do the interventions asked of him, the task of depending on others for help may be difficult. As a farmer, it is difficult to let someone else do the chores the patient is usually doing on a daily basis. The fifth health deviation self-care requisite is accepting the fact that sometimes self or others need medical help when faced with certain life challenges. This health deviation self-care requisite is a strength for the patient. When DN realized his knee was not functioning at the level he needed it too, he sought help from professionals after trying alternative treatments. When DN had his prostate removed due to prostate cancer, he also pursued help from many specialists to deal with the many complications a prostatectomy can cause. The sixth health deviation self-care requisite is learning to live productively with the effects of pathologic conditions and treatments while promoting continued personal development. This is a strength for the DN because he looks forward to having better function in his knee to live a more productive life. The chores he does on the farm were becoming difficult with the increasing pain in his knee prior to the surgery. The patient now talks enthusiastically about getting back out on the farm to do the things he loves to do. Nursing Diagnosis I. Nursing Diagnosis #1: Acute Pain related to tissue trauma caused by surgery and intense physical therapy regime as evidenced by patient verbalizing his pain an 8 on a 1-10 scale. a. Expected Outcome: Patient verbalizes relief of pain as less than a 3 on a 1-10 scale at least thirty minutes after administration of pain medication. i. Intervention #1: Assess the patient’s description of pain and effectiveness of pain-relieving interventions. 1. Rationale: Assessing pain description leads to the best interventions to control the pain, as well as assess for any complications with a different pain description. Every patient has a right to effective pain relief (Gulanick & Vallerand, 2007). ii. Intervention #2: Instruct the patient to request pain medication before the pain becomes severe. 2. Rationale: Relief will take longer if the patient waits until the pain is too severe (Gulanick & Vallerand, 2007). The best pain control is proactive, not reactive. iii. Intervention #3: Administer narcotic analgesics as ordered by the doctor. 3. Rationale: With all of the tissue damage done during surgery, the nurse should assume the patient is in pain and needs analgesics (Gulanick & Vallerand, 2007). a. Implementation/Evaluation: Nurse assessed the patient’s description of pain to adequately treat the pain symptoms. Nurse taught the patient the request the pain medication at the onset of pain to reduce the amount of time it takes to start working. The goal was met because the patient verbalized his pain less than a 3 on a 1-10 scale within 30 minutes of administration of pain medication. b. Expected Outcome: Patient appears comfortable as evidenced by absence of facial grimacing and use of stress management techniques between doses of pain medication and throughout hospital stay. iv. Intervention #1: Nurse will teach patient to use guided imagery and progressive relaxation. 4. Rationale : Use of guided imagery and progressive relaxation will distract patient from the pain he is experiencing (Gulanick & Vallerand, 2007). v. Intervention #2: Nurse will teach patient to change position frequently. 5. Rationale: Changing positions (within limits) will relieve pressure and pain on bony prominences, reduce muscle spasm, and undue tension (Gulanick & Vallerand, 2007). vi. Intervention #3: Nurse will apply ice packs as ordered. 6. Rationale: Applying ice packs may decrease edema and enhance comfort (Gulanick & Vallerand, 2007). b. Implementation/Evaluation: Nurse taught the patient different comfort measure to relieve pain in between doses of pain medication. Using repositioning and relaxation measures helped the patient stay comfortable between doses of pain medication. The goal was met. II. Nursing Diagnosis #2: Impaired physical mobility related to pain after surgical procedure as evidenced by limited ability to ambulate. c. Expected Outcome: Patient will maintain optimal mobility within limitations throughout hospital stay. vii. Intervention #1: Assess postoperative range of motion in affected and unaffected joints. 7. Rationale: Assessment of range of motion will give a baseline to see if the patient is improving. Range of motion exercises are important to strengthen affected joint (within limitations) and unaffected joints need to maintain current mobility in periods of decreased activity because joints with arthritis lose function more rapidly (Gulanick & Vallerand, 2007). viii. Intervention #2: Nurse will assist patient to ambulate with less assistance as tolerated. 8. Rationale: This will allow for patient to become more independent before discharge (Gulanick & Vallerand, 2007). ix. Intervention #3: Nurse will encourage the patient to move from the bed to the chair as tolerated, as well as ambulate in the room three times a day. 9. Progress will be monitored toward normal activities patient will do once discharged from the hospital (Gulanick & Vallerand, 2007). c. Implementation/Evaluation: Nurse assessed postoperative range of motion to have a baseline of function. Improvement was noted th roughout shift that the patient was able to move more independently. d. Expected Outcome: Patient participates in rehabilitation program throughout hospital stay. x. Intervention #1: Assess the patient’s fear or anxiety in ambulating and going to physical therapy. 10. Rationale: If the patient’s fear and anxiety is too great, the patient may not get the full benefit of physical therapy and is at a greater risk for falls or other injuries (Gulanick & Vallerand, 2007). xi. Intervention #2: Nurse will encourage use of supportive walking devices, such as a walker. 11. Rationale: Use of a walker will help the patient feel more independent and encouraged to go to physical therapy as ordered. More weight bearing will progress throughout the use of walker (Gulanick & Vallerand, 2007). xii. Intervention #3: Nurse will reinforce instructions for rehabilitative activities as ordered. 12. Rationale: Reinforcing instructions will help the patient achieve mobility throughout the hospital stay and adhere to the physical therapy program (Gulanick & Vallerand, 2007). d. Implementation/Evaluation: The patient was enthusiastic about physical therapy and gaining full mobility of affected leg. He participated in the rehabilitation program and was able to go home on schedule, so the goal was met. III. Nursing Diagnosis #3: Self-care deficit related to impaired mobility as evidenced by inability to perform activities of daily living, such as dressing, bathing, and ambulate independently. e. Expected Outcome #1: Patient will safely perform all self-care activities of daily living independently before discharge. xiii. Intervention #1: Nurse will assess the patient’s ability to perform activities of daily living. 13. Rationale: This will provide a baseline to know where the priority deficits in the patient’s performance of ADLs and help nurse assist with the patient’s needs (Gulanick & Vallerand, 2007). xiv. Intervention #2: Assist the patient in accepting help from others. 14. Rationale: The patient may need to realize after a total knee replacement, some assistance may be needed and dependence on people or supportive devices may be necessary temporarily (Gulanick & Vallerand, 2007). xv. Intervention #3: Nurse will implement measures to facilitate independen ce, but be available to help patient when needed. 15. Rationale: Giving the patient independence will help encourage patient to attempt ADLs on his own, but with assistance when needed will prevent falls or other injuries (Gulanick & Vallerand, 2007). e. Implementation/Evaluation: Nurse assessed the patient’s ability to perform activities of daily living and realized where the patient needed assistance. Patient was encouraged to do ADLs on his own, but to recognize and ask for help if he needed it. Patient was able to ambulate on his own the bathroom, perform most activities independently, but required some help from his wife by discharge. This goal was met because the patient realized when he needed help and performed all ADLs safely by discharge. f. Expected Outcome #2: Resources are identified that are useful in optimizing the autonomy and independence of the patient by discharge from the hospital. xvi. Intervention #1: Nurse will assess what assistance will be needed when the patient is discharged. 16. Rationale: This will be helpful to the patient and other caregivers to recognize deficits until they are overcome (Gulanick & Vallerand, 2007). xvii. Intervention #2: Nurse will encourage patient to use assistive devices until no longer needed, and reassure patient that use of them can prevent falls and injuries. 17. Rationale: This allows patient to know total independence is not expected just because the patient is being discharged (Gulanick & Vallerand, 2007). xviii. Intervention #3: Nurse will help the patient set short term goals to becoming more independent. 18. Rationale: Setting short term goals will decrease the frustration the patient may have in not being able to do activities he could do before surgery (Gulanick & Vallerand, 2007). f. Implementation/Evaluation: Nurse assessed what assistance may be needed to help with activities of daily living. Patient used assistive devices and help from others when he recognized he could not do them independently. Short term goals were set and patient was able to be discharged with a walker and home health services. This expected outcome was met. IV. Nursing Diagnosis #4: Risk for ineffective tissue perfusion related to surgical procedure and impaired physical mobility. g. Expected Outcome: Patient maintains adequate tissue perfusion and remains free from deep vein thrombosis, as evidenced by warm extremities, good capillary refill, bilaterally equal pulses, negative Homan’s sign, and stable vital signs. xix. Intervention #1: Assess neurovascular status of affected limb preoperatively and postoperatively, as well as assess for signs and symptoms of deep vein thrombosis. 19. Rationale: Preoperatively a baseline should be established and assessing for changes postoperatively will be indication of a problem. Signs and symptoms could be an early indication of a blood clot which leads to early intervention (Gulanick & Vallerand, 2007). xx. Intervention #2: Nurse will assist patient in using thromboembolic disease support hoses and sequential compression devices as prescribed. 20. Antiembolic devices, such as TED hose and SC Ds, increase venous blood flow to the heart and decrease venous stasis, which could prevent a blood clot (Gulanick & Vallerand, 2007). xxi. Intervention #3: Nurse will administer thrombolytic and anticoagulant agents as ordered. 21. Rationale: Prophylactic anticoagulants will reduce the risk of deep vein thrombosis and thrombolytic drugs may decrease the complications if a blood clot does develop (Gulanick & Vallerand, 2007). g. Implementation/Evaluation: Patient was assessed preoperatively and postoperatively for neurovascular status. Patient was monitored closely for any signs of ineffective tissue perfusion. Nurse encouraged use of antiembolic devices and patient adhered to regimen. The goal was met because ineffective tissue perfusion was not a problem and not deep vein thrombosis developed. V. Nursing Diagnosis #5: Deficient knowledge related to a new procedure and unfamiliar with the discharge plan as evidenced by patient questioning health care team members about the process. h. Expected Outcome: Patient verbalizes understanding of procedure and discharge instructions. xxii. Intervention #1: Assess the patient’s current understanding of process in hospital and discharge instructions. 22. This will allow the nurse the individualize the teaching plan for the patient and teach only what the patient does not understand (Gulanick & Vallerand, 2007). xxiii. Intervention #2: Nurse will review total knee arthroplasty precautions according to what the patient does not already know, for example, using the walker, maintain proper body weight, and when to notify the physician. 23. Rationale: Reviewing the information will reinforce adherence to the rehabilitation program (Gulanick & Vallerand, 2007). xxiv. Intervention #3: Nurse will explain the discharge follow up instructions, and reinforce the need to continue with home health for physical therapy. 24. Rationale: Home health and physical therapy will increase the patient’s strength to have a full recovery. When the patient understands the process, he will be more motivated to continue with the program (Gulanick & Vallerand, 2007). h. Implementation/Evaluation: This goal was met. The patient had a full understanding of the limitations of a knee arthroplasty, in the hospital and after discharge. He understood the follow-up appointments and how home health would assist in his recovery. VI. Nursing Diagnosis #6: Constipation related to inactivity and medication use as evidenced by patient having frequent but nonproductive desire to defecate. VII. Nursing Diagnosis #7: Risk for infection related to invasive procedure. VIII. Nursing Diagnosis #8: Risk for falls related to unsteady gait and pain in left leg. References Berman, A., Snyder, S., Kozier, B., & Erb, G. (2007). Fundamentals of nursing: Concepts, process, and practice (8th ed.). Upper Saddle Road, NJ: Pearson. Caton, B. (2007). Orem’s self care requistes. Handout for NUR100 Fundamentals of Nursing. Missouri State University-West Plains, Fall 2007. Deglin, J.H., & Vallerand, A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia: F.A. Davis. Gulanick, M., & Myers, J.L. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis: MO: Elsevier. LeMone, P., & Burke, K.M. (2004). Medical-surgical nursing: Critical thinking in client care (3rd Ed.). Upper Saddle Road, NJ: Pearson. Pagana, K.D., & Pagana, T.J. (2006). Mosby’s manual of diagnostic and laboratory tests (3rd ed.). St. Louis, MO: Mosby. Total Knee Replacement (2009). American Academy of Orthopaedic Surgeons. Retrieved October 19, 2009, from http://orthoinfo.aaos.org/topic.cfm?topic=A00389.

Immigration Act of 1924 Essay

From the late 1800s to mid 1900s there were many Acts and restrictions for foreigners to come into the United States. The Immigration Act of 1924 was very important because it had many effects on immigration and in US population. There were three factors that probably influenced Congress to pass the Immigration Act of 1924. These three factors were due to ethnic control, economic issues, and political control. First of all, Americans wanted to stay â€Å"white†, they did not wanted aliens to come and mix with their culture to produce an inferior race. â€Å"Many of these alien people are temperamentally and racially unfitted for easy assimilation† (Document F). In other words they were inferior to Americans, their race did not fit with the one of Americans. Also, they were not â€Å"temperamentally† capable to live in American society. â€Å"Thank God we have in America†¦ the largest percentage of†¦ pure unadulterated Anglo-Saxon stock; certainly the greatest of any nation in the Nordic breed† (Document I), said Ellison D. smith in 1924. Again in this phrase we can find Americans finding themselves superior to any other type of race. The same year in which the Immigration Act was passed Mr. Keaton from the Department of Adjutant of the American Legion of California wrote to John Raker in the House of Representatives in Washington, DC that he was â€Å"standing behing†¦ 100 per cent in the fight to make this a white man’s country† (Document G). Once again we can find proof that one of the most important reasons why the Immigration Act of 1924 was passed was because the United States wanted to have control over ethnicity. Secondly, Congress had to study very well how would immigrants affect US economy. The United States Bureau of the Census shows a table from 1919 to 1925 showing national and personal income during those years. In here we can se the sharpest declines between 1920 and 1921. By 1924, the year in which the Immigration Act of 1924 was enforced, economy was getting better, but not fast enough, and so they thought immigrants were affecting economy. (Document D). â€Å"There is not now the relative advantage for the peasant of England, Germany, or Scandinavia†¦ As regards the new immigrants†¦the one great reason for their coming is that they believe that on the wage which they can receive in America they can establish a higher standard that the  one to which they have been accustomed† (Document C). Congress was limiting more Southern Europeans than Northern because they were poorer and could not bring any benefits to the country. â€Å"We need three generation to educate, to crossbreed with Western strains and to assimilate a large number of those that we have here now† (Document F). This suggests that inferiority is would not last forever but the bulk of the argument indicates clearly that the effort to â€Å"Americanize† the new, particularly the â€Å"new immigrants† will exhaust America’s resources had ultimately prove impossible. Thirdly, having political control was very important also. Congress felt that by allowing people from different countries with different government will try to change the way America was governed. For example, communism was something Congress was afraid. It was the time when Bulsobism was trying to infest the US with its communism. The US was afraid that in those immigrants a group of Bulsobist could sneak in introduce bad habits to Americans. Philadelphia inquirer, 1920 (document E), shows a communist immigrant under the US flag trying to get it through the United States boundaries. Concluding, we find proof, once again, of the fears that the United States has and this is why American Congress takes drastic caution towards immigrants who could affect the US. â€Å"Under the act of 1924 the number of each nationality who may be admitted annually is limited to 2 per cent of the population of such nationality resident in the United States according to the census of 1890† (Document A). This Act was mostly influenced by the factors of economy, ethnic and political control.

Ottoman Empire and the Turkish Republic Essay Example | Topics and Well Written Essays - 750 words

Ottoman Empire and the Turkish Republic - Essay Example Prior to the transition to the Turkish Republic, the old Ottoman Empire embarked on a series of reforms to â€Å"save† the old Ottoman Empire through the efforts of Selim III, Mahmud II, Abdulaziz and Abdulhamit II that hoped to reverse its decline. These men were called the Men of Tanzimat or men of reform in their effort to reverse the decline of the old Ottoman Empire. The efforts to reform the old Ottoman Empire that hoped to reverse its decline included military reform during the time of Selim to improving the educational system and bureaucratic reform in the hope of restoring the glory of the empire. When these reform efforts still failed, the last Ottoman caliph Abdulhammit II resorted to an autocratic rule and adopted religious ideology in his hope to unify and reverse the decline of the old Ottoman Empire. But instead of reversing the decline, Abdulhammit II instead set the conditions for the inevitable fall of the old Ottoman Empire with his lavish lifestyle that dra gged the empire into bankruptcy and was eventually deposed in 1909. The final nail on the coffin of the old empire’s demise was when the old Ottoman Empire sided with Germany in the First World War where the country was divided into pieces to become Turkey that it is today. This change to a Republic political life was not a conscious choice of the old Ottoman Empire as it always struggles to maintain the caliphate political system embarking on a series of reform from rehabilitating its military to improving its educational system and bureaucracy but it was already too late. Not even the adoption of a western concept of a Constitution saved the empire from disintegration. In sum, the old Ottoman Empire was forced by both by internal (bankruptcy, ineffective bureaucracy) and external (siding with Germany who lost in the First World War I) circumstances to change and adapt with the modern world.   The strong western ideology had also influenced the old empire to adapt to moder nity and along with it, is the abandonment of caliphate political system and autocratic form of government to constitution based republic form of government.   Despite these changes in Turkey’s political life and structure, the old traces of the former Ottoman ideology can still be found in modern Turkey.   Among this Ottoman ideology that remained in Turkey and in the Middle East is the strong sense of Islamic nationalism which used to bind and unify Turkey before.   Its sense of the greatness of being a great empire did not diminish with present Turkey as it is considered as one of the progressive countries in the Middle East and in the world albeit it is only a fraction of its former might when the former Ottoman Empire was at its height.      

The Ethics of living Jim Crow and Euripides Essay

The Ethics of living Jim Crow and Euripides - Essay Example They fought with weapons such as cedar poles while hiding behind trees. That war was taken a notch higher when the white boys started using broken bottles in their warfare, which resulted in Wright getting an injury on the head (Wright 289). As Wright becomes elderly, he is forced to look for a job and the only place he can get one is from white people. His whole experience of working for white people is not smooth since he comes across hostile white people. In some jobs, he is forced to leave since he is tortured and in others he adapts by applying tactics from past experiences (Wright 292). The point of this autobiography is the exemplification of the various survival skills Wright employed as a Negron in a Whiteman environment. Wright learnt how to get what he wanted from a hostile environment and people by applying tactics and strategies which he had learnt the hard way (Wright 298). Medea is a play by Euripides, and its context is based in Corinth. Medea got married to Jason after betraying his father, and they ended up getting two children. The initial stages of the play depict that Jason has changed his mind and wants to marry Creon’s daughter named Glause. At the same time, Jason has intentions of exiling his wife and two children from Corinth. Medea is to be thrown put of Corinth reason being that she is a sorcerer. Creon and Jason see Medea as someone who is clever and capable of fighting against oppression. They decide to exile her from the country, reason being, she is a sorcerer which means she is cleverer that men (Luschnig 10). The play is about Medea, a clever woman who is hated by most people around her. The play’s sole theme is on the issue of women oppression. In particular, Medea goes through injustice when Jason and Creon conspire to banish her out of the country. In the play, women are subjected to subjugation by their male counterparts. The play further shows that women are limited in terms of socializing