Amputation Of Arms And Legs Health And Social Care Essay

Amputation Of Arms And Legs Health And Social Care Essay Multiple health need is a theoretical account to have an comprehensive view on multiple interwebbing needs of a client which pairs health and social issues. There cannot be a common frame work for the complex needs for all, but it is individual specific and need separate response from care givers. (Rankin Regan) Client Discussion A 37 year old client named Mr Shaiju came to the emergency department with alleged history of road traffic accident (RTA) in which a lorry ran over the tibia of the left leg. On admission Mr Shaiju had immense pain over the left leg and was having tachycardia and hypotension. The skin over the left tibia was degloved and the client looked apprehensive .On radiological examination Mr Shaiju was diagnosed with a compound fracture of tibia and fibula. The orthopedician advice for a Below knee Amputation since there was popliteal artery injury along with nerve injury and bone fracture, which when associated together in patient is a higher risk to end up into amputation (K. Rerkasem 2006), even though the patient had history of Type II diabetes Mellitus by considering the finding of Guo Jiong Jiong et al (2009) that immediate operation is possible in a patient with fracture. The client was moved with traction splints to Surgical Intensive Care Unit (SICU) after taking routine investigatio ns like blood routines (HIV , HbSAg screening, Liver Function Test, CBC ESR and Urine Routine, Random Blood test, Urea , Creatinine) and ECG . In SICU Mr Shaiju was prepared for surgery. Amputation is the method of surgical removal of a limb or a portion of limb which no longer be beneficial for the person, instead it produce immense pain and cause threats to the life of individual because of injury or infection. Below Knee Amputation is the process of surgical removal of lower portion of leg beneath from knee joint (Riley Lee Richard 2005).This can arise to many interlinking needs for the patient like economical social, psychological demands which are not directly linked with condition but play a crucial role in the recovery of the patient Relevance In order to mention the multiple health needs of the patient with below knee amputation, practitioner use the above mentioned case of Mr. Shaiju who was a victim of RTA because he was drunken and driven cycle into a lorry and broken the tibia and fibula of right leg along with injury to both nerve and artery resulted in below knee amputation. This client is a perfect example of a case of multiple health need of patient undergone amputation since he is having all needs To protect confidentiality all the persons are mentioned with pseudo names in accordance with Nursing Midwifery Guideline in 2008 The subject of this case study Mr Shaiju is a 37 year old who has been admitted in authors unit with severe injury to right lower limb because of RTA.On physical examination his height was 168 cm weight was 68kg and Body Mass Index (BMI) was .He was hypotensive with Blood Pressure and Tachycardic .On auscultation he was having crackles and he was having an episode of cough since one week. He was having a surgical mark on the left iliac region of abdomen. He was having a muscular build and the rest of all system was functioning normally. He was assessed for fracture, abdominal or head injury by observation, neurological examination and also an abdominal ultra sonography and results of all those were negative. System wise Examination 1. General Appearance: Muscular body built. He was apprehensive and cooperative to author despite of severe pain he was having. 2. Skin: Good skin turgor,but skin is dry and pale over palm and lower extremity 3. Head a) Skull is normal, round appearance with no sign of injury or bruise mark. b) Hair is thick and some are white in colour c) No visible facial abnormalities 4. Eyes a) Pupils are equally round and reactive to light and accommodation b) Eyebrows are equal c) No evidence of periorbital oedema d) Cornea is smooth e) White sclera 5. Ears a) No foul smelling discharge present b) Normal position of pinna c) Recoil of pinna is present when it is folded 6. Nose: No abnormal discharge present 7. Throat Mouth: No obvious swelling and sore present, Normal Deglutition and gagging reflex present. 8. Neck a) No visible enlargement of thyroid gland and jugular vein distension 9. Chest: Normal appearance, no gynecomastia present 10. Cardiovascular: No cardiac murmurs, normal rhythm of pulse 11. Respiratory: Crackles on the both lungs with frequent coughing 12. Gastrointestinal: No organomegaly present and normal bowel sounds present. 13. Extremities: No abnormality found other than crush injury over right lower limb 14) Urogenital System: Normal urine output present, no haematuria or pyuria present 15) Neurological System: Normal reflexes present Past Medical History The past medical history was not good when the operation while considering the possible complication associated with it. Shaiju had severe medical histories like Type II Diabetic Mellitus (DM), hypertension and also chronic alcoholism He was diagnosed of having diabetics in 2006 and was on regular oral hypoglycaemic. In the year 2007 he was diagnosed of a victim of chronic renal failure as hypertension is a main predisposing factor for the disease ( ).He was on regular haemodialysis as this is the best treatment option available for chronic alcoholism ( ) beside with the supportive medication. Past Surgical History He had undergone appendicectomy one year before and the operative and post operative history was uneventful. He had developed a heterogeneous mass in the hilum of liver and on later examination it was found to be a cyst and Endoscopic retrograde collangiopancreatography (ERCP) was performed .On ERCP gallstones and stone on hepatic duct was found out and removed and a drain was put to remove pus collection from the cyst. Living Standard Family History He is having a nuclear family with wife and three children and he is the only bread winner of the family. His parents were died because of old age and cause of death according to him was because of Cardiac Arrest. His uncle and mother was having DM and hypertension. He had four siblings in which three of them died because of cancer and another one recently died because of RTA, so he was very stressed since he also encountered with an accident. Financial Status He is a coli worker and belongs to a socially deprived group of society. He did not have support from any other family member since he is the only earning member and his other relatives are belong to low socio economic strata .The subject was living in a rented house. The roof was tiled and having accessibility to safe water. Nutritional Status He was well nourished and is a non vegetarian. He was taking foods four times a day and had at least 8 glass of water per day. MANAGEMENT AND TREATMENT Crush Injury of Lower Extremity Physiological Function  ¿Ã‚ ½ To bear the weight of the body.  ¿Ã‚ ½ To enable in locomotion. The main focus of the orthopedician is to manage the condition by below knee amputation, even though that may be considered as the failure of surgeon to perform amputation since due to the advancement of surgery in micro vascular technique, revascularisation and internal fixation of fracture (Ertl Jan 2005). But in this case the bone was fragmented due to crush injury by RTA.A transtibial procedure was used. Informed consent was taken from the patient and the risk for above knee amputation was explained. The patient was given supine position and tourniquet was applied. An anterior-posterior incision was used. The muscle layer was dissected first and followed by the neurovascular structures. After the soft tissues dissected the osseous tissue is approached using chisel. After the dissection is performed anterior flap is attached to posterior flap. Drains are placed to prevent the formation of hematoma and the extremity is wrapped in sterile dressing and plaster cast is applied with le g in extension. The splint was removed on 7th day, as the normal duration will be between 2-7 days (Ertl Jan 2005). The patient was on broad spectrum antibiotics since he was a high risk candidate for infection due to diabetics mellitus ( ) and NSAIDS. ALCOHOLISM ALCOHOL WITHDRAWAL SYNDROMME Alcoholism is a condition arises because of either psychological or physical strive alcohol is consumed which is manifested by behavioural and responses of other kind and is associate with a temptation to consume alcohol to get its physiological effect or to nullify the effects caused if you not taking alcohol. (World Health Organisation 1992). Alcohol Withdrawal syndrome is a group of clinical manifestation which arises due to the reduced concentration of alcohol in the blood , which is essential for the normal functioning of that individual since the body developed dependency to alcohol ( Winnington J et al 1998 ) Pathophysiology The reduced intake of alcohol because of long post operative period caused decrease of alcohol levels in patients ¿Ã‚ ½ blood so that body cannot perform the normal function, since his body developed dependency. The withdrawal symptoms were sweating in night, tremors, increase in heart beat and respiration, reduced amount of sleep, agitation and irritability. He was aggressive and also had auditory hallucination. Treatment. The patient developed alcohol withdrawal syndrome on the 3rd post operative day, the common complication of alcohol abstinence after a long history of drinking. The patient was referred to psychiatrist and was advised to give Polybion an Intravenous drug of multivitamin and Serenenace tablet in order to make the patient calm. Diabetes Mellitus Diabetic Mellitus (DM) is a metabolic disorder in which there may be absolute or relative absence of insulin hormone or resistance of insulin or a combination of both which deter the proper carbohydrate, fat and protein metabolism. DM is of two types 1. Non insulin dependent diabetes mellitus or NIDDM or Type II DM 2. Insulin dependent diabetes mellitus Anatomy Physiology Pancreas is an endocrine gland situated behind stomach and it is in the left upper quadrant of abdomen .It is an exocrine as well as endocrine gland. . The two important hormones are Glucagon and Insulin. The former convert glycogen stored in body tissues to glucose for meeting energy requirement and the later do vice versa that is glucose to glycogen. Pancreas is having three pats head neck and tail. It is supplied by pancreaticoduodenal and splenic artery and pancreaticoduodenal vein. Pathophysiology The risk factors for DM can be grouped as non modifiable( age, family history , ethnic origin) and modifiable risk factors (Obesity, hypertension, polycystic ovarian disease , viral infection , drugs , stress and gestational diabetics mellitus ) .Mr Shaiju had family history ,and hypertension . These caused hyperglycaemia. The hyperglycaemia cause increased glucose uptake which penultimately leads to cellular starvation and ultimately in polyphagia since satiety centre is stimulated because of the starvation. The hyperglycaemia causes increased glucose elimination from kidney since it exceed renal threshold. This result in polyuria since more water will be gone out since glucose will attract the water. The hyperglycaemia increase blood osmolarity which in turn result in polydypsia since intracellular dehydration occurs as fluid shifts from intracellular to extra cellular space and also it result in reduced blood flow which causes complication of diabetics like dry itchy skin, nephrop athy, neuropathy, retinopathy and confusion. Mr Shaiju was devoid of complications and had polydypsia, polyphagia and polyuria. Treatment Throughout the days the blood sugar level of patient was very much raised due to underlying history of diabetics and stress due to hospitalisation. The patient was advised to start insulin injection subcutaneously from 2nd postoperative day since the oral hypoglycaemic agents was found ineffective, with the advice of doctor specialised in diabetics. Chronic Renal Failure (CRF) Anatomy Physiology Kidney is a retroperitoneal bean shaped organ situated between T12 and L3 vertebrae and is guarded by 11th and 12th ribs. The basic functional unit of kidney is Nephron. The physiological functions are excretion , controlling the fluids in blood , maintain ionic regulation of pH of the body fluids, it share the function of synthesising vitamin D along with skin, and it maintain red blood cell concentration. CRF is a disease condition in which kidney cannot maintain body ¿Ã‚ ½s normal internal environment since there occurs gradual progressive deterioration in the number of functioning renal tissues. Pathophysiology There are predisposing factors (Age above 55 Family history of DM and Hypertension) and precipitating factors (Life style like smoking and alcoholism, certain diseases like hypertension and DM, recurrent infections). Mr Shaiju had the family history of DM and hypertension and also had both diseases and he was a chronic alcoholic. These factors caused thickening of small vessels and deposition of collagen in them resulting in decrease blood flow. This causes glomerulosclerosis and thereby reducing glomerular filtration rate (GFR).This result in gradual progression through 5 stages according to the Kidney Disease Outcome Initiative Classification. Stage I: GFR will be normal (>90ml/min/1.73meter square) Stage II: GFR will be mildly reduced (60-89ml/min/1.73meter square) Stage III: GFR is moderately reduced (30-59 ml/min/meter square) Stage IV: There occurs severe reduction in GFR(15-29ml/min/meter square) Stage V : There occurs failure of kidney ( Mr Shaiju was on 4th stage of CRF and had pruritis, anorexia, and decreased libido. Treatment The patient was having a history of chronic renal failure and hypertension so he was given antihypertensive (ACE inhibitors), loop diuretic, vitamin and mineral supplements and especially Vitamin D supplement. There was a high concern for the worsening of the disease because of the high course of antibiotics science kidney is the organ meant for excretion of waste products of drug metabolism ( ) . He was on protein restricted diet. The author as a nurse practitioner looked the patient holistically like physical, psychosocial and economic dynamics rather than particular disease. PHYSICAL DYNAMICS Alcoholism is associated with many medical problems which is harmful for the normal functioning of the body. It also is the causative factor of RTA as in the case of him ( in United Kingdom one in seven RTA is due to alcoholism) and problems with co-ordination ( Ritson Bruce 2000).There will be a great expectation of the patient for health care professionals to ask about the drinking habits of the patients (Kaariainen et al 2001).The hospital is the best site for prevention since the admitted patient in the hospitals demonstrate high willingness to change (Emmon et al 1992).The nurse practitioner used this opportunity to identify yhe dangerous alcohol consumption habit of the patient and given counselling as stated by Lock et al on 2002. The nurse practitioner identified the risk of developing contractors a major concern after the amputation (Christian Adrian 2006) and also the physical movement act as the stimuli in mechanical form for the skeleton in maintain normal homeostasis of bones (Lundon Katie 2000).The immobilization cause sudden loss of bone mass (Krolner et al 1983). So the patient was given range of motion exercises along with physiotherapists. The residual limb was covered with elastic bandage so that the residual limb attains proper shape and is devoid of swelling (Christian Adrian 2006). Mr Shaiju had muscle pain skin pain and bone pain and he was given health education regarding that the former two will diminish quickly and the later will last longer as quoted by Erhl Jan in 2005. The patient was given special care for phantom limb sensation and given massage from mild to severe pattern and also towel used , both for desensitization so that the nerve reflex is reduced (Riley Lee Richard 2005).The pat ient was given health education that residual limb should be kept covered and elevated in order to enhance blood supply and wound healing. From physical examination nurse practitioner identified the crackles in the lungs and cough. The patient was given chest physiotherapy and steam inhalation so that the present condition was relieved. The stress of operation results in an increased circulatory adrenaline, adrenocorticotrophic hormone, cortisol and growth hormone which result in deficiency of insulin in body and also develop resistance to insulin (Heller 2002). The nurse practitioner identifies the tough job to find out hypoglycaemia in a sedated patient after surgery since the diabetic patient. The patient ¿Ã‚ ½s blood glucose was checked half hourly to relieve the risk of hypoglycaemia and its complication. The nurse practitioner identified the risk of decline in physique and functional capability in haemodialysis patient (Johansen L Kirsten 2003). Adequate attention was given for this aspect and patient was approached with that mind set and was referred to dietician for preventing malnutrition. PSYCHOSOCIAL DYNAMICS The nurse practitioner given information regarding the temporary problem with verbal, visual and spatial learning, which would be regained within few weeks if the chronic alcoholics abstains from alcohol (Ellenberg Leah 1980).The point about the alcohol hinders the performance of suitable form of behaviour and self interpretation regarding events happened in past (Hull G Jay 1981) was informed to patient. The patient was also informed regarding the loss of functioning in which alcoholics deter better processing of information and physical activity and also the increases chance of aggression after consumption of alcohol (Hull g Jay1986). ECONOMIC DYNAMICS The term diabetes mellitus denote a severe issue to health care because of the increasing cost and the hindering nature of disease on the individuals affected to live a better quality of life. The complications of DM can be prevented by proper primary care which reduce two third of the cost. Physical activity and weight regulation promote reduction in the expenditure for mortality and morbidity (G John 2009). REHABILITATION The nurse practitioner coordinated the rehabilitation team which consist of dietician, social workers, occupational therapist by proper referrals, informing the proper condition and improvement of patient and helping them in the rehabilitation process.

American Dream or Nightmare?

To understand the American dream it’s easiest to look back in history at how great historical movements created and shaped the American dream idea. For starters a long time ago around the 30’s, James Truslow Adams, a popular historian, was putting the final touches on the preface to his latest book. It was an interesting time in the life of our nation. Though the crash of 1929 had signaled the beginning of the Great Depression that was to be endured for years to come, there was also a spirit of progress, of possibility.On the day Adams was finishing his manuscript, President Herbert turned on the lights of the newly opened Empire State Building. High hopes amid hard times: the moment matched Adams' thesis in his book, â€Å"The Epic of America† (Meacham 1-4). A history of the nation that was to spread a term not yet in the general lingo in those last years of the reigns of Harding, Coolidge and Hoover. Adams' subject, he wrote, was â€Å"that American dream of a better, richer, and happier life for all our citizens of every rank which is the greatest contribution we have as yet made to the thought and welfare of the world. , (Meacham 1-4). It was not a new thing, this abiding belief that tomorrow would be better than today. â€Å"That dream or hope† (Meacham 1-4). There is no single definition of the American Dream. Different people in the US have a different perception of the idea of American Dream. The history of American Civil War helps people understand the two different views regarding the American Dream. All thirteen colonies of the pre-independence era fought together against the British forces. By the end of the American Revolution however, things had changed.The southern colonies had different views which didn't match with those of the northern states. The northern states were against the tradition of slavery and wanted a federal government to rule the nation. They also favored the growth of industries in America. Southern states on the other hand, wanted a sovereign state for them; they also supported the system of slavery which provided them with cheap labor. Interests of these states lied more in the area of agricultural development as against industrial growth. These clashes and differences in opinions eventually culminated into the Civil War.Today, many Americans have lost their faith in the idea of the American Dream. Again John Muller’s ideas from â€Å"Capitalism, Peace, and the Historical Movement of Ideas†, talks about a great point about the US Government. â€Å"Imperialist policies of the US Government more than the economic crisis are responsible for the occurrence of this situation. Interestingly, the efforts of USA to establish superiority over other countries were perceived as a part of the American Dream by many† (Mueller 169-184). James Field JR. explains the history of war from his book â€Å"History of United States Naval Operations: Korea†.After the for mation of Canada, there was no territory left in North America for the US to expand. Thus, the US turned to the east and supported South Korea against North Korea in its effort to weaken China's influence in the region. After helping South Korea in regaining its territory from North Korea, the US decided to invade North Korea. Chinese authorities warned them against taking any such steps. However, the tensions between these countries rose and eventually the Korean War broke out. A 200,000 strong Chinese army attacked the UN (United Nations) forces which supported the US.Fearing the intervention of USSR, the UN forces retreated back to the south. James Field JR. goes on to conclude â€Å"The reason behind citing these instances is that, in the process of asserting itself as a superpower, America went so far as to suppress the weaker nations. The imperialistic policies of this country have therefore, acted against the very essence of the American Dream i. e. Liberty/freedom. In order for the American Dream to exist and thrive, the US should not only strengthen its economy, but also act as a responsible nation. † This is why the American Dream has and never will be feasible.The Idea of the American Dream has become so prevalent in today’s motto and goals that it is literally ruining people lives. People line up at the proverbial starting line and originate a pissing contest in an attempt to attain degrees, cars and houses at an unreasonable debt, get jobs that we loathe, and max out our credit cards along the way. In the midst of this survival battle, people are keeping their eyes toward what they were all told about attaining the â€Å"dream† that includes a home, family, and acquiring as many things as we can.So why is the American dream so important to everyone if there is no such thing as it? The first myth that America obtains as a nation is that anybody can succeed with hard work. For everyone to succeed with hard work, that would requi re equality of opportunity, which does not exist because opportunity differs based on class and status. The American dream justifies inequality based on social class by your position in class as a fair reflection of what you deserve. Justifying inequality based on ascribed status attributes inequality to a personal trial or defiance in the minority group.James Tueslow Adams states that the American Dream is a dream of a land in which â€Å"life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement. † Too many of us have grown weary and mistrustful of it. It is not a dream of motor cars and high wages merely, but a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position.The United States has always been considered a land of equ al opportunities. People from all over the world have migrated to the US, mainly in search of employment and freedom of religion. However, there are many factors responsible for making America a sought-after destination in order to lead a prosperous life. The United States is a nation where the ‘individual', rather than collective population attains ‘center-stage’ in the process of devising policies, making changes, taking up developmental initiatives, etc. Alperovitz, and Thomas 18-23) The youth from the Third World nations have always found USA to be attractive; for them, the socioeconomic conditions back home are in contrast with those found in America. The freedom which can be experienced in America is nowhere to be found. However, there is also a darker side to the American society which needs to be understood. The American Dream has been flawed by social evils like slavery, racism and recently by the grand policies of its government.John Mueller author of â €Å"Captialism, Peace, and the Histroical Movement of Ideas† writes that, the promissory note of ‘all men are created equal' in the Declaration of Independence was rendered meaningless when Negroes were used as slaves (Mueller 169-184). Just like any other nation, America too has its limitations. In order for the American Dream to exist, it’s a necessity to eliminate these social evils prevalent in the American society. The second myth for the American Dream to exist is that free capitalism is the growing achievement of our democracy. For example Fair employment.

If You Read Nothing Else Today, Read This Report on Gre Analytical Writing Solutions to the Real Essay Topics Pdf

If You Read Nothing Else Today, Read This Report on Gre Analytical Writing Solutions to the Real Essay Topics Pdf However you get ready for the essays, make sure you at least write a couple of each type before you take the actual GRE. There are quite a lot of websites which can help you in evaluating your essays and also in supplying you with useful GRE sample essays. Not only do you have to read through GRE sample essays, but you also ought to look for topics on which you are able to write GRE sample essays yourself and have them evaluated. If writing essays isn't your forte, then you must sit up and take stock of the quantity of preparation that you'll need for getting a great score in the Analytical Writing test section of the GRE. The Analytical Writing Measure is merely one portion of the GRE, but, together with your scores on the opposite areas of the test, helps to predict your capacity to be prosperous in graduate school. 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Managing Across Cultures Russia and Germany Free Essay Example, 4500 words

Diversity in the workplace and organizational culture also affect expatriate s work because people are likely to face problems of gender, marital status, conversations at the workplace, use of non-verbal communication in both Germany and Russia. Furthermore, expatriates should consider the negotiation styles of the two countries. This report, therefore, focuses on dimensions of culture, workplace diversity, communication and negotiation styles of the two countries. The Hofstede s model provides six dimensions of culture: power distance, individualism, masculinity, uncertainty avoidance, pragmatism, and indulgence. Different countries have different scores in terms of each Hofstede s dimension of culture. In other words, people in different countries have different values and beliefs. These differences cause significant challenges to expatriates in their international assignments. Power distance is concerned with the fact that individuals in different the society cannot be equal. Acc ording to the Hofstede Centre (2014), power distance refers to the level in which members of the society with less power in organizations or institutions expect and accept that power is not distributed equally. Russia has a high score in terms of power distance. This indicates that power is very distant in the society. We will write a custom essay sample on Managing Across Cultures: Russia and Germany or any topic specifically for you Only $17.96 $11.86/pageorder now This is also demonstrated by the fact that Russia has one of the most centralized systems in which 2/3 of all investments are concentrated in Moscow (Bodin et al 2013, p. The great difference between the less powerful and the more powerful indicates that status symbols are treated with great importance in Russia. Behavior in the region should also represent status roles in various interactions in the society. For instance, interactions in business organizations should be top-down and provide clear roles for each task. On the other hand, the score of Germany on power distance is low. The country is characterized by a strongly decentralized system and mainly occupied by the middle class (The Hofstede Centre 2014). In organizations and institutions of Germany, co-determination rights are taken into account quite extensively.