Ascites Is A Special Case In The Medical Geriatric Ward Nursing Essay

Ascites Is A Special Case In The Medical Geriatric Ward Nursing Essay Background I think ascites is a special case in this Medical Geriatric ward, because I saw this only one case of ascites in this four weeks practicum. And it is my first time that care patient with ascites. Therefore, I interest and choose this case for studying the nursing care of ascites. In this total patient care study, I will talk about the information and relevant clinical data about this case, the pathophysiology of ascites, the nursing assessment, care plan within patient hospitalize period 20-21/09/2010, plan for future management, and what I learn from this case. Case presentation Patient X is 72-year-old male. He lives in old age home, chair bound for activities of daily living. He is dependent Comprehensive Social Security Assistance, exsmoker and exdrinker. He was admission to Accident Emergency at 20/09/2010. He complained that increased abdominal distension for 2 days, poor appetite, shortness of breath. Physcial condition: conscious, SaO2 95% under room air, afebrile, chest clear, no ankle edema. His primary diagnosis is cirrhosis and gross ascites. He has chronic renal impairment, diabetes mellitus, alcoholic cirrhosis of liver, and chronic ascites. Last time admitted from 05-07/09/2010 for ascites, therapeutic abdominal tap was done and 1.3L ascites fluid was removed. Ascites is an accumulation of extracellular fluid in the peritoneal cavity abnormally. It is the most common major complication of portal hypertension following liver cirrhosis. Blocking the blood flow through the liver sinusoids to hepatic veins and vena cava lead to increased pressure in the portal venous system. It results in plasma leaks out directly from the liver capsule and the congested portal vein into the peritoneal cavity. In addition, hepatocellular damage reduces the livers ability to synthesize normal amounts of albumin, which may deteriorate by leakage of protein in ascites. The evidence of hypoalbuminemia shows in the blood test that the albumin was 24g/L, which is a low level. Adlosterone cannot activate by liver to stimulate the kidneys to retain sodium and water due to hepatocellular damage. Thus, sodium and water are still retention, and the volume of peritoneal cavity fluid grows continue. In this case, the medical management can be performed to patient X should be paracentesis or abdominal tap. This procedure involves using a thin needle to pull ascites fluid from the abdomen (George Longstreth, 2009). Large-volume paracentensis repeated done in combination with Albumin administered intravenously, which can avoid a sudden drop in blood flow in the arteries and to replace each liter of removed ascitic fluid. The physician prescribed IV administration of Albumin 40g after tapping and 30g. 10500ml milk like in color of ascites fluid was removed. If ascites is recurrent, therapeutic abdominal tap may need to be done every two weeks or more frequently, and need to remove up to 10 liters ascites fluid (Cirrhosis Ascites). Ascitic fluid analysis also done before for provides a sample of fluid for analysis, which help for determine the underlying cause of the ascites. No malignant cell was found. An abdominal x-ray and ultrasonography study was done to comfier the presence of ascites. It may locate fluid in the peritoneal cavity. The result did not show dilated bowel. A low sodium and protein diet with restriction of fluids 1L per day. Edema in the form of ascites brings about shallow breathing and impaired gas exchange, as a result of respiratory compromise. We need to Promote and maintain an effective breathing pattern, Arterial blood gas analysis and pulse oximetry monitor every four hours were ordered. Potassium- sparing diuretic Frusemide tablet 40mg twice a day was prescribed. Nursing assessment In abdominal assessment, inspect for skin integrity (pigmentation, lesions, scars, veins, and umbilicus, etc), contour (flat, rounded, etc), distension, respiratory movement, visible peristalsis, and pulsations. Then to auscultation of the abdomen, warmed the stethoscope and the hands, light pressure act on the stethoscope is sufficient to detect bowel sounds and bruits. Then perform percussion of the abdomen; abdominal percussion is aimed at detecting fluid in the ascites, gaseous distension, and masses within the abdomen. Percuss lightly on abdomen according to auscultation site at each abdominal guardant. The sound will be dull if the ascites is presence. Measure the abdominal girth circumference. Assess the amount of distress leaded by the ascites that ask the patient whether the fluid is interfering with sleeping, eating, and breathing (Head-To-Toe Assessment (R. Abdomen), 2008). Nursing diagnosis Excess fluid volume and deficient fluid volume related to fluid shifts secondary to portal hypertension, hypoalbuminemia. It is a combination of volume problem for patient with ascites. The expected outcomes of this care plan are that a normal balance of fluid in the peritoneal cavity will be maintained as evidenced by normal serum albumin levels, without of hypovolemia, decreased abdominal girth, and normal blood pressure measurement. Electrolyte or acid- base are balance. For nursing intervention, monitor the intake and output of patient daily, and record the IO chart. Output should be equal to or exceed intake. Strictly restrict the patients fluid intake. If possible, administer medication with meals, so mealtime fluids can be used for taking medications. Assess the patients dietary intake and habits that may lead to fluid retention. Limit high sodium intake, because it can lead to increased water retention. Administer albumin and diuretics as physician prescribed. Aspirin and nonsteroidal anti-inflammatory drugs may inhibit prostaglandin synthesis and impair sodium excretion by the kidney. Thus, it needs to avoid administering them. Weight the client and measure the patients abdominal girth daily. Closely monitor the patient after paracentesis procedure. To ensure the client has tolerated the procedure well, check the vital signs frequently. Check the dressing carefully to ensure that there are no losing excessive amounts of fluid. Use a pouch to co llect leaking fluid if necessary. Ineffective breathing pattern related to increased intra-abdominal pressure on the diaphragm. The expected outcomes of this care plan are that the patient express relief of feelings of faulty breathing pattern as a result of no shortness of breath and the presence of normal respiratory excursion. Patient has a normal respiratory rate, compared with baseline. (Lynda juall carpenito-moyet) For nursing intervention, position the client in a high-Fowler position with an arm supported with pillows. It can facilitate breathing and relieves the pressure acting on diaphragm. Monitor the clients respiratory status (crackles and increased respirations) for the development of atelectasis or pneumonia to identifies fluid in lungs. Encourage the patient to deep breathe and cough. Use an incentive spirometer to maintain and monitor the respiratory function. If the cough does not loosen to expectorate reparatory secretion, patient can receive ultrasound treatment For improving gas exchange, administer oxygen and blood products as ordered. Teach the patient some breathing techniques, such as pursed-lip breathing to overcome poor breathing patterns (Lynda juall carpenito-moyet). To evaluation the outcome, treatments of ascites enable the client to breath with minimal difficulty. Imbalanced nutrition: less than body requirements related to increased pressure on stomach and intestines, feeling of fullness, poor appetite. The expected outcomes of this care plan are that patient X has appetite and he can keep or increase body weight to an ideal weight and consume sufficient nutrients. Identify deficiencies in daily intake. For nursing intervention, measure the body weight daily to monitors the weight gain or loss. Monitor hemoglobin, hematocrit, albumin, total protein values for monitoring the intake of nutrients, presence of anemia, and colloidal osmotic pressure. Offer and encourage oral hygiene before meals, because poor oral hygiene may cause bad odor and taste, which can reduce appetite. Encourage the patient to rest before meals due to fatigue may decrease appetite and ability to eat. (Lynda juall carpenito-moyet) Provide small, frequent meals for patient instead of few large ones, because even distribution of intake can help to prevent feeling full and ensures enough nutritional intake. Determine food preferences and selected low or no protein and low salt (no more than 1500 mg/day of sodium). If possible, encourage the patients relative to bring permitted foods from home. Prevent constipation to reduce abdominal pressure and fullness. Administer Lactulose liquid 20mal three times a day as physi cian ordered. Plan for management after discharge, patient x should back to the old age home and have follow up by community geriatric assessment service. Recommend short the follow up clinically admission if symptomatic ascites occur. Refer PCU home care nurse for visiting and symptom assessment, and admission clinically for symptom management. Learning points After this total patient care study, I have learnt that more understand the cause and care of ascites. And know that to provide a holistic care not only physical nursing care, but also we need to care the patient mental, social, finical condition, and discharge planning Make sure patient can have a complete care after discharge. Word count: 1452 Black, J. M. Hawks, J. H. (2009). Medical-Surgical nursing: Clinical management for positive outcomes. Missouri: Saunders. George F. Longstreth MD http://www.healthline.com/adamcontent/ascites#ixzz11s5PVSzi Head-To-Toe Assessment (R. Abdomen) (Head-To-Toe Assessment (R. Abdomen), 2008) (Cirrhosis Ascites). http://www.healthcentral.com/ency/408/guides/000075_11.html

The battle between religios

Christianity vs. Judaism Did you know that Christianity evolved from Judaism? In fact in the Old Testament, which is part of the Bible, were the words of the Jews (Southwick). You may have never heard of Judaism because it is such a little religion that not many people practice. Although Judaism is such a small religion it means a lot, without it there would not be Christianity! Therefore, there are many similarities between Christianity and Judaism; however, there are also many differences. Christianity is the largest religion in the entire world, 32. of are world's population is Christian (Southwick). There are also thousands of different types of Christianity. As of right now there are about 33,820 â€Å"sub† religions, Catholic being the biggest with about 1,050,000,000 members (Wikipedia). Think about that, over 1/7 of the world is made up of Catholics. Christianity is one of many monotheistic religions meaning they believe in one god and that goes by the name of Jesus. J esus is actually of three people; God the father, God the son and God the Holy Spirit. They call this trinity which is a group of three people or things.Most Christians go to church very Sunday for about an hour and listen to the stories of God read out of the Bible. On the night before Christmas and the day of Christmas people usually go to church to celebrate the birth of Jesus. Christianity is not a very extensive religion compared to most, there are very few requirements. The only thing you really need to do is believe in God/Jesus and you also must be baptized. This is probably why it is such a large religion. Unlike Christianity, Judaism is not a very large religion. Only 0. 2% of the world's population s made up of this religion.Compared to 32. 5% (Christian population) 0. 2% is not very much. This religion started in a place called Canaan and now a days Judaism is mainly practiced in Israel. Dissimilar to Christianity, 52% of Jews do not believe in gods. Appose to what most Christians think, most Jews do not thing God was the messiah. The sacred text of the Jews goes by the name of the Torah, which are the first five books of the Old Testament. The Torah was given to the people by God. Judaism is also a monotheistic religion. Jews did not eat shellfish or meat. https://donemyessay.com/why-was-the-battle-of-gettysburg-so-important/All of their meat had to be kosher. A big part of the Jews faith is to respect your elders! If you disrespected your parents they would have the right to beat you. One of the mail holidays in the religion is Hanukkah and is celebrated during the month of December. There are far more requirements to the religion which is probably why there are very few people that are a part of the religion. Because Christianity came from Judaism there will be many similarities but since Christianity started a lot have things have changed making it different from Judaism.One thing they have in common is that they both follow the Ten Commandments. They also both attend church and read out of the holy book. The Bible includes the first five books of the Old Testament which makes up the Torah. A major difference is the majority Jews do not believe Jesus Christ was the messiah. On the contrary; Christians believe that Jesus is the messi ah. Jews pray to Jehovah. Also Jews has different main day of worship then Christians. The Jews main day of worship is on Saturday oppose to Christians which is on Sunday. the battle between religios By noahwatsonl

How Energy Division Lead to Major Losses for Sime Darby

There are 4 multimillion Ringgit projects entered by Energy and Utilities division of Sime Darby, but turned out bad. One of the projects is collaboration with Qatar Petroleum (QP), the Bulhanine and Maydan Mahzam project. Sime Darby has been awarded a RM265 million contract to build wellhead platforms where the scope of works in the contract covers three wellhead platforms, installation of about 40 kilometres of pipeline, 23 kilometres of umbilical and alteration to existing platforms. It started in April 2006 and supposedly completed in August 2008. However, the division has encountered delays and cost overruns which resulted in losses on the project exceeding RM500 million, which have already been accounted for. At that time, they still try to negotiate with the QP project’s client on claims for the over budget cost, but the Board has already decided to reverse the revenue of RM200 million previously recognized in the Group accounts for Financial Year 2009. The second project is the Maersk Oil Qatar project (MOQ). Maersk Oil awarded Sime Darby Engineering the EPCIC contract to build and install a process platform, a utility platform and three bridges off the coast of Qatar in February 2007. It was scheduled for completion in October 2009 but there have been delays and cost overruns in this project which caused losses of RM159 million for Financial Year 2010. According to Sime Darby, the cost overruns were incurred on transport and installation, and hookup and commissioning works. It is not clear if the overruns were the result of under-budgeting, and unexpected increase in raw material costs, or both, or some other reason. Even though negotiations were made with the client, they still could not probe the losses. The third project related with the MOQ project, which is the construction of vessels for the MOQ project’s usage called the Marine Project. MARINE Project was meant to turn Sime Darby Bhd into a major marine vessel player in the oil and gas industry, but it didn’t turn out as planned when they picked the wrong shipbuilder. The project including building a derrick-lay barge, a pipe-laying ship, an anchor handling towing supply, and a tug boat that could send supplies to offshore oil rigs. Sime Darby had suffered cost overruns of some RM1. 3 billion for all three projects. And the last project is the Bakun hydroelectric dam project. The project was tendered to Sime Darby Group along with seven-member consortium by the government at a total of RM 1. 788 billion. The Bakun hydroelectric dam project, in which Sime Engineering Sdn Bhd holds a 35. 7% effective interest, was awarded in September 2002 and was initially scheduled for completion in September 2007. However, due to various factors, completion has been delayed and costs have escalated. There are three developments affecting the Bakun project. The first is the merger of the Sime Darby, Guthrie and Golden Hope into a new entity named Synergy Drive. The second is the proposed takeover of the Bakun project by the contractor, Sime Engineering. The third is the revival of the submarine HVDC cable under the South China Sea to transport electricity from Borneo to Peninsular Malaysia. These four projects were under the former president and four other senior executives’ control. They are Datuk Seri Ahmad Zubir Murshid (CEO), Vice-president Datuk Mohamad Shukri Baharom, chief financial officer Abdul Rahim Ismail, head of oil and gas Abdul Kadir Alias and senior general manager of Sime Darby Engineering Mohd Zaki Othman. These personnel were accused of failing to carry out a due diligence on all projects. It also has been reported that they had neglected findings from KPMG, specifically on the deals with MLC shipping Group (construction and sale of four units of anchor handling towing supply at RM285 million and construction of a derrick lay barge for a sum of RM 295 million) and Puteri Offshore Pte Ltd. The VP was blamed for disregarding the due diligence process when he did not disclose or sufficiently highlighted the fact that he had already signed deals with MLC and Puteri Offshore. Sime Darby also has done investigation conduct by the legal and forensic consultants which has validated the finding where they may have been breaches of duties and obligations and inappropriate conduct.

Hell And Heaven Essays - Religion, Mythology, Belief, Hell

Hell And Heaven Essays - Religion, Mythology, Belief, Hell Hell And Heaven Matthew Jay Krachunis May 2000 Hell The idea of heaven entices and encourages believers and non-believers alike. It is enjoyable to envision a place of eternal rest and relaxation, in the presence of God and loved ones. Heaven does exist according to the Bible, and is the destination of the believer in Jesus Christ at the completion of life on this earth. What is not encouraging is the fact that there is a place for those whom God chooses will not inherit everlasting life. This place is commonly referred to in the English language as hell. It is not metaphorical nor is it mythological, it is real in every sense of the word; a true literal hell. It is a time as Guthrie says in New Testament Theology, to inquire about the state of the lost, a subject which tends to be neglected or else glossed over.....the final state of those who are not in the book of life (Guthrie p. 887). This will be the focus of this discussion, the eternal state of those individuals whose name will not be found in the book of life. To fully understand the implications of the declaration of a place of eternal damnation, one must first understand what that place is. The common use of the word Hell is considered colloquial and comical to some. In the bible, the idea of the term hell is expressed in more ways than one. The terms Gehenna (Matthew 5:22), Hades (Matthew 11:23), and Lake of Fire (Revelation 20:15) are terms that have been interpreted to believe as hell. The term Gehenna occurs twelve times in the King James version of the bible. It occurs in all three of the synoptic gospels, but most notably in the book of Matthew in which it occurs seven times. Strongs Exhaustive Concordance of the Bible defines Gehenna as A name for the place (or state) of everlasting punishment:-hell (Strongs p. 19). Jesus Christ spoke of Gehenna and warned people of it. Jesus said in Matthew chapter five verse thirty, for it is better for you that one of the parts of your body perish, than for your whole body to go to hell. It is as Guthrie says, There is no way of avoiding the conclusion that Jesus firmly accepted that there was a counterpart to heaven for those who were condemned before God (Guthrie p.888). It is clear that Guthrie believes that there is an eternal and literal hell. Therefore, because Jesus stated it, and Guthrie supported it, shows that it must have a certain importance about it. In Mark chapter nine verses forty-two through fifty, Jesus is talking about the importance of understanding of the implications of a sinful life and where it will lead. In the following passage, the usage of the word hell is interpreted as the Greek word Gehenna and Jesus says, If your hand causes you to sin, cut it off. It is better for you to enter life maimed than with two hands to go into hell, where the fire never goes out (Mark 9:43). It can be construed from this statement that Jesus is adamant about the reality of the conditions in hell. It can be assumed that Jesus is not advocating the actual removal of the hand, but is speaking about the horrifying reality of hell. He is admonishing those who are listening to understand that theoretically, not having one of your hands would be better than spending eternity in hell. As Stamps says in the notes of the Full Life Study Bible, the place of unquenchable fire is so terrible that every influence of sin must be opposed and rejected no matter what the cost (Stamps p. 1497). Clearly, hell is an eternal existence that would be far worse than a missing limb. Next, Stagg states in The Broadman Bible Commentary that Gehenna was a term that came to symbolize the place of judgment for the wicked (Stagg p. 109). Furthermore, Stagg declares that Gehenna is derived from Hinnom, a valley west of Jerusalem, where the garbage was burned from the city (Stagg p. 109). The aforementioned passages reinforce the idea that hell is not a rhetorical or spiritual existence but a

Computer Tech essays

Computer Tech essays We are living in the era of a knowledge revolution and are entering an informative society. Information capabilities of computers have made possible multinational corporations, and their analytic and imaging capabilities have made possible scientific and engineering breakthroughs. Both at individual and institutional levels, computer technologies suggest fundamental changes in the organization of everyday life. So, what kind of tool is a computer, and in which way do people get engage with computers? Computers are objects that are becoming dominant features in the human environment. Initially, computers were not socially neutral (i.e. residual ideologies when computers were first launched); they were substitutes for humans and were defined as only appropriate for certain social roles belonging to young faculty and graduate students, signifying their lack of resources to hire human support staff. As time passes, people soon began to realize that computers have the potential for uses in diverse kinds of workplaces, diverse applications, and varied transformations in work (i.e. emergent ideologies as people began to understand the importance of computer existence). Now, in general, computers are intended as a dominant medium for introduction of technical pedagogy, problem solving, into education settings and with other pedagogies. Since computers are general-purpose devices, they are used for a variety of applications. There are many disciplines, professions and technologies where computers have become of central importance. For instances, as in education, computers are completely accepted into the mainstream activity. It is also clear that computers will play an increasing large and eventually dominant role in our everyday life. Computers often make more efficient use of resources and hence, they provide the ultimate rationale for precision and efficiency. Indeed, computers are everywhere. People view computers as...

Week 4 assignment Essay Example | Topics and Well Written Essays - 500 words

Week 4 assignment - Essay Example The young man who slipped was actually carrying a package that fell and causes some fireworks that seemed to have hurt Plaintiff. The package fell on the Platform where Plaintiff was standing and was actually estimated to have been fifteen inches of feet. It was due to the injuries caused by the package explosion that Plaintiff decided to sue or file a case. History: When the case was presented on the trial court, Plaintiff was actually found for by the court and the defendants were forced to appeal making the judgment to be affirmed by the appellate court. Ruling/ Analysis: Negligence in a real life situation is believed not to be a tort until it leads to a wrongful act that tend to deprive or violate one of his or her rights (Furgeson et.al, 2008). It is therefore right to show the possibilities of the obvious danger if harm was not willfully done. Since Plaintiff’s harm did not happen willfully as per the defendant’s part, it was therefore right to prove that package drop, had the obvious prospect of danger(Furgeson et.al, 2008). Being that the package was wrapped and there was no more evidence to prove that it had explosives, no negligence was thrown away. Negligence was not found and railroad had nothing to do with Plaintiff’s injuries. Judge Andrew actually opposed and started defining negligence. In his statement, he said that negligence is a comparative notion and everybody is to stay away from an act or substance that can intrude or interfere with the safety of others(Furgeson et.al, 2008). Summary: Actually, nothing was found in the situation to imply as the wrapped package could have dropped for anybody as this means that no one could have evaded such a situation. Plaintiff’s injury was caused by the explosion and this act was invisible as no one was aware of the incidence. This is one of the reasons as to why Judge Andrew reversed the

Reserve Banking Essay Example | Topics and Well Written Essays - 500 words - 2

Reserve Banking - Essay Example There are two types of banking system that is the fractional banking system, and the 100% reserve banking system. This paper is a comparison and a contrast of these two types of banking system. The 100% reserve banking system is a practice whereby the full amounts of the funds of a depositor are made available to him or her at any given time. In the current global business environment, this system of banking does not exist. This is ever since the 1800s. The major reason is because banking organizations need to make profits, and having a 100% reserve banking system makes it difficult for these organizations to make money (Quagliariello, 17). Therefore, banking organizations and institutions would trade with the deposits in their vaults, for purposes of making profits. These trades involves, issuing of loans, mortgages, and involving themselves in the money market. However, in order to make some money, banking organizations that operates under a 100% reserve banking system, are involved in charging their customers some money, just for purposes of making them to be able to access their services. Lending in this kind of a system normally occurs when there is a separate arrangement, between the depositor and the banking organization, where the depositor is required to authorize the banking organization to lend some of his or her money. This is in direct contrast to the fractional system of reserve banking (Quagliariello, 27). Under this type of banking system, only a fraction of the depositor’s money is able to stay in the banking vaults, and the rest of the rest of the money are used for purposes of trade. Banks normally loan out these money, at an interest. Banks normally carry out this activity, through a vehicle referred to as a certificate of deposit. This system normally works, when the banking organization takes the money that is not needed by the customer, and it