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Abdominal Hysterectomy Surgery Patient

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Around 40,000 elective hysterectomies take place each year, mostly on women aged between forty and fifty years old (NHS 2010). Hysterectomy has a profound effect on a women’s health because of the complex mix of biological, physical and social factors. This assignment will follow an integrated care pathway (ICP) of a female patient undergoing total abdominal hysterectomy (TAH) surgery and will consider the preoperative, perioperative and postoperative care the patient will receive. The assignment will critically discuss the area of patient controlled analgesia when managing a patient’s pain postoperatively. There are several different types of hysterectomy which involve the removal of the uterus and depending on the underlying condition sometimes involve the removal of the ovaries, fallopian tubes or cervix. TAH is the removal of both the uterus and cervix usually through a horizontal incision in the abdomen just above the public bone, on occasions where there is abdominal swelling or scar tissue a vertical cut may be necessary and should only be considered if less evasive procedures have been unsuccessful (Pudner 2010, NHS 2010). An ICP gives health professionals a guideline based on evidence based best practice to giving care whilst assisting a patient through a clinical procedure, such as surgery (RCN 2009). Its aim is to reduce risk and ensure each patient receives high quality care by guiding the multidisciplinary team on the care required from the pre-operative assessment through to discharge (RCN 2010). Following major surgical procedures patients experience improved outcomes if they have received holistic care (Hilton 2004). Therefore an ICP should give guidance on the patient’s psychological and social needs in addition to physical needs (NHS 2010). The care pathway chosen is entitled: Major Abdominal Surgery – Gynaecology and appears in the first instance to meet this criteria (NHS 2010). Prior to the operation the patient will attend a pre-operative assessment clinic which is often led by a Registered General Nurse (RGN) supported by other multi-disciplinary team (MDT) members involved in the surgical process such as surgeons, consultants, anesthetists, pharmacists, therapists and social workers, providing an integrated approach to holistic care (Manley and Bellman 2000). The aim of the pre-assessment is to assess the patient’s fitness for both surgery and anesthetic to minimise complications during and after surgery and to explain to her what is involved in the procedure. She will be encouraged to involve family in discussions so they can support her after hospital discharge (Pudner 2010). Assuming the patient gives written consent, the MDT will carry out a medical review. Gaining valid consent is both a legal and ethical requirement which should always be obtained prior to giving treatment or physical examination (NMC 2008). In surgery consent is an ongoing process and the MDT should ensure its validity before giving any care or treatment at any point (Dimond 2008). Any medications including herbal remedies will be reviewed by pharmacy such as the introduction of Hormone Replacement Therapy, or some patients take regular aspirin which they should stop prior to surgery due their antiplatelet properties (Davey and Ince 2000). The patient’s general medical background including obstetric and menstrual history, present illness, allergies and pre-operative tests will enable the anesthetist to assess if the patient is fit enough to go ahead with surgery in conjunction with the American Society of Anesthesiologists recommendations (ASA 1991). The RGN will carry out a nursing assessment, quickly establishing a rapport with the patient which is important to maintain through to discharge to thoroughly explore any anxieties or fears she may have. Patients are mostly afraid of anesthetic and pain but other fears associated with undergoing a hysterectomy may include altered body image, femininity, sexuality or inability to reproduce (Pudner 2010). Consistent, clear, evidence based advice and information should be given to the patient, which will include admission to hospital, pre-operative fasting, length of stay in hospital, the effects of surgery and anesthesia, control of pain, any possible complications and recovery (Dougherty and Lister 2008). Surgery can mean different things to different people; therefore provision should be made for specific cultural and spiritual requirements. For example a Buddhist patient may refuse certain drugs which alter mental awareness that are contained in the anesthetic (Hollis 2009). The patient should be made aware of the importance of being in optimum health pre-operatively and be advised on any weight loss and smoking cessation issues (Pudner 2010). TAH is grade three major abdominal surgery (REFERENCE). The routine pre-operative tests according to the ICP include taking the patient’s vital signs of temperature, pulse, respirations, oxygen saturations and urinalysis which will provide baseline to monitor changes or deterioration during and after surgery (Dougherty and Lister 2008). Height, weight, body mass index (BMI), blood glucose monitoring (BM) and Methicillin-resistant staphylococcus aurous (MRSA) screening will be required as will blood tests including U

Nursing Essays – Morphine Fantanyl Pain

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Morphine Fentanyl Pain Effective Pain Relief In Post Operative Patients. Is Morphine or Fentanyl more effective in reducing pain in postoperative adult cardiac patients? Pain is physiological mechanism and a means of the body alert the person about either currently present or impending damage to it. It can be defined as the “unpleasant sensory and emotional experience associated with actual or potential damage” (Gélinas, 2004). Consequently, the words discomfort has also been used interchangeably with pain in the past and can be defined as a “negativeaffective and/or physical state subject to variation in magnitudein response to internal or environmental conditions” (Gélinas, 2004). Pain is a very important component in care of the surgical patients, both preoperative and post operative. Surgery itself afflicts large amounts of trauma on the patient. The pain that the patient has to incur afterwards adds his anxiety levels and stresses the body. Lack of or inadequate amounts of pain management by the staff, impacts the patients healing process. Their mobility and in the long terms their duration of hospital stay is also affected. It is important that, for optimal patients health management and care, a means tool must be available to measure the patients pain assessment and relief requirement through pharmacological and non pharmacological means. Little research has been done to properly assess and document the prevalence of pain and its management protocols in post operative patients. The pain scoring systems are available to attempt to quantify pain and manage it accordingly. These subjective ones include the categorical rating scales (CRS) in which patient rates pain from “No” to mild moderate or severe. Another one is the “Visual Analog score (VAS) where the individual scores are placed on a 10-cm line where the left anchor point is labeled “no pain” and the right anchor point is labeled “worst possible pain”. (Venkateswaran, P., 2006) Since every patient has a varying threshold for pain, and requires varying levels of drugs, to over come the pain, it is better for there to be both a subjective indicator for pain as well as an objective one, that is to say, that the nurses an also assess how much pain the patient is in, by using a tool she is provided with. Cardiac surgery is a major thoracic surgery and patients post operatively require lot analgesics to manage pain so that their morbidities associated with pain (like pain in breathing, walking etc) can be eliminated. Usually morphine is used for the purpose of pain relief but there are indications that Fentanyl can perform a similar relief without much of the side effects associated. There needs to be some focus into this theory. This can be achieved by placing 2 similar populations of adult cardiac patients who have just undergone cardiothoracic surgery on morphine or Fentanyl. As is the standard procedure nowadays, quality indicators, both subjective and objective can be used. The VAS pain scoring card can be provided to the patients for them to record the different levels of pain that they feel. The nurses would be provided with indictors to record objective findings which can indicate pain. “These can be physiological and behavioral indicators. The physiological indicators can be clustered into cardiovascular, respiratory and cerebral responses” (Gélinas, 2004). Pain associated responses would include tachypnea in respiratory, tachycardia and increased blood pressure in cardiac and raised ICP in cerebral responses. After assessment of the pain levels with the quality indicators, the pain management drugs will be administered and later the subjective and objective pain assessment will be repeated to see which drugs effects were greater and lasted longer. A study conducted by Céline Gélinas on critically ill incubated patients, to find out what are the protocols and tools used to assess pain management are and if the patients were being given effective relief. He used subjective as well as objective tools. The results revealed that physicians placed no role in documenting pain in patients. Most of the reporting was done by nurses and the patients. It was also noticed that nurse’s assessment of pain was much less than that reported by the patients themselves. The research concluded that the documentation overall about the pain and its management was incomplete in general with little attention being given. The research also noted that even after being notified about the pain, its effective management only took place 60 percent of the time. (Gélinas, 2004). In and interventional study conducted by Françoise Bardiau in 2003, the quality indicators e.g. VAS were introduced in the surgical and anesthesia department. After a survey of assessment of knowledge of nurses, VAS to assess pain was the nurses worked to improve pain management. After further surveys, it was noted that initiation of programs to setting of quality indicators improves the overall pain management system. (Bardiau, F., M, 2003) Idvall E tested a 5 point scale to measure the effects of quality indicator maintain pain relief measurements. “The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated”. (Idvall E 2002) A multidisciplinary program development was introduced based on evidence based medicine to focus on construction of proper management protocols to implement clinician as well as patient based pain relief programs “The results suggest that addressing pain management through a variety of strategies targeted at the level of the institution, the clinician, and the patient may lead to desired changes in practice and better outcomes for patients.” Bédard, D (2006). A survey conducted on post operative cardiac ICU patients, about their pain experiences revealed that despite the pain management regimes in place nowadays, the pain frequencies, and intensities were the same as they were more than a decade ago. Pain management is a vital component of patient care. Quality of pain management can only be assessed through proper indicators. These can be multimodal. The patient populations on which these indicators can be applied are preoperative and postoperative patients. Post operative cardiac patients under nursing care can benefit well from implementation of quality indicators such as VAS. In the nursing profession subjective scoring by the patients themselves enables the nurses to manage the pain properly. This will lead to quicker recovery by the patients and earlier discharge. In the long term this means leads financial implications on the patients due to reduced hospital stay. Also nursing work load gets reduced as the patient tern over is increased. The healthcare cost gets reduced. A Post operative pain management (POP) project was conducted in 2003. A nationwide survey was done to see the implementation of quality improvement projects in the field of pain management, it was noted that more than 70% of the hospitals were reportedly satisfied with the implementations and the outcomes of the quality improvement programs. Summary Based on the analysis, it is noted that on the positive side, proper implementations of the quality indicators and improvement programs in the healthcare system and especially in the ICU and surgical wards, the patients stay can become quite comfortable. The stay can be reduced and the cost of healthcare to the system, the insurance companies, and the patient themselves can be reduced. In the other hand we can clearly see that by using the indicators we in effect are placing more workload on the nurses. If the subjective VAS and the objective physiological changes in the patient has to be monitored regularly just to assess the pain levels, a lot of quality time will be wasted. This time could have been used to tend to more critical patients. Now the question arises if it is worth the effect to implement the QI programs. The answer would lie in Force field analysis and the Lewin’s theory. If the benefits out way the set backs, we can implement the system. The idealistic thing would be that we assess the pain management needs of each department of the health care system and implement the QIs in the ones in which the implementation benefits out way the costs. References Bardiau, F., M., Taviaux, N., F., Albert, A., Boogaerts, J., G., Stadler, M, (2003), An Intervention Study to Enhance Postoperative Pain Management. Anesthesia and Analgesia. Retrieved on February 26th, 2008, from http://www.anesthesia-analgesia.org/cgi/content/abstract/96/1/179 Bédard, D (2006). The pain experience of post surgical patients following the implementation of an evidence-based approach. Pain management nursing. Retrieved onFebruary 26th, 2008, from http://www.find-health-articles.com/rec_pub_16931414-pain-experience-post-surgical-patients-following-implementation.htm Gélinas C, Fortier,M., Viens, C., Fillion, L., Puntillo, K., (2004). , Pain Assessment and Management in Critically Ill Intubated Patients: a Retrospective Study. American Journal of critical care. Retrieved on February 26th, 2008, from http://ajcc.aacnjournals.org/cgi/content/full/13/2/126 Idvall E., Hamrin E., Unosson M. (2002). Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management. Journal of Advanced Nursing. . Retrieved on February 26th, 2008, from http://www.ingentaconnect.com/content/bsc/jan/2002/00000037/00000006/art02130;jsessionid=2n189mrighst7.alice?format=print Venkateswaran, R., Prasad K. N., (2006). Management of postoperative pain, Indian journal of anesthesia. Retrieved on February 26th, 2008, Share this: Facebook Twitter Reddit LinkedIn WhatsApp

Adaptive and Rational Reactions to the Impact of Macroeconomic Stabilisation Policies

best assignment help After defining Adaptive Expectations and Rational Expectations, explain how the conclusions on the impact of macroeconomic stabilisation policies (and, in particular, disinflation policies) differ depending on whether the agents’ expectations are adaptive or rational. Present arguments in favour or against these two theories. Adaptive expectations is an economic theory which focuses on the events which have occurred in the past to predict future events. The theory is clearly displayed when predicting inflation. Under adaptive expectations if the rate of inflation had increased in the last years, people would predict and expect for the rate of the inflation in the upcoming year to be higher therefore in the adaptive expectation hypothesis people base their expectations of inflation relying on past inflation rates. The adaptive expectations model is quite simplistic, assuming people base future predictions on what happened in the past. In the real world, data from the past is a factor which has an effect on behavior in the future. During the time whereby inflation is moving in an upward or downward trend adaptive expectations are limited. Therefore it creates the situation where in a period of rising inflation agents which use adaptive expectations make systematic errors. If for instance agents forecast a given variable in a given period to be below the expected then people were assumed to adapt their expectations of the future value in the following period to be higher. In the case of inflation whereby the inflation rate is turns out higher than expected, people would adjust, and revise their forecasts for the future inflation upwardly. These limitations led to the development of rational expectations which incorporated many factors into the decision making process. As opposed to adaptive which follows backward-looking rules. Where people often assume to have static expectations which means that they expect the future to be like the present. This assumption is used when explaining investment decisions with a Phillips curve. Rational expectation is a model which suggests that people are more forward-looking and do not base their expectations on past trends rather they follow current economic policy and look forward to a certain outcome. An example of this would be during the economic policy of an interest cut or a government inflationary tax cut whereby people expect inflation to take place and do not wait for its’ occurrence. Although rational expectations expect that an average person has a high level of economic knowledge and insight with abilities to formulate expectations on their knowledge of economic reactions to certain economic policy. Economic theory states that during the process of decision making individual agents will base their decisions on the best information available in order to avoid previous errors and learn from past trends. The theory differs from adaptive expectations as agents used all available information and thereby systematic errors are avoided the agents use models to form their expectations of outcomes. Thereby the rational expectations theory holds the assumption that people learn from their mistakes and errors made in the past. As people hold expectations for future outcomes due to their knowledge this will have implications on economic policy as people expect the policy to have a certain outcome the impact of economic policy such as expansionary fiscal policy will be different. Most empirical studies of wage or price inflation have used past inflation rates, rather than the concept of wage norms, to help explain current inflation. The effect of lagged inflation in these models has generally been interpreted as representing the influence of inflationary expectations on current inflation, where these expectations are formed by an adaptive process. In such models, developments affecting inflation continue to have an influence long after they occur. And the effect of a sustained shock affecting inflation grows with the passage of time. Because the lagged inflation terms directly embody long-run and expectational effects, a sustained macroeconomic policy change is not expected to alter either the constant term or the coefficients of the equation relating output and inflation. New classical models differ in important respects from either of the models just described. They reject adaptive expectations as a description of how future price expectations are formed. Generally they relate these expectations to the policies that are anticipated, but that idea has never been implemented in a widely accepted way in a predictive equation. The problem is in determining what economic agents expect policy to be and what amount of inflation they think will accompany it. These models also hypothesize that markets always clear and that in doing so they incorporate expected future prices in an important way. In the pure form of such models, levels of output and employment deviate from full employment levels only because economic agents are mistaken about policy now and in the future. They interpret the very flat short-run Phillips curve estimated from historical data as a reflection of mistakes by economic agents resulting from unpredictable policies. The problem is in determining what economic agents expect policy to be and what amount of inflation they think will accompany it. These models also hypothesize that markets always clear and that in doing so they incorporate expected future prices in an important way. In the pure form of such models, levels of output and employment deviate from full employment levels only because economic agents are mistaken about policy now and in the future. They interpret the very flat short-run Phillips curve estimated from historical data as a reflection of mistakes by economic agents resulting from unpredictable policies. The central policy implication of this theory is that policy should be steady and predictable, a prescription usually interpreted as supporting monetarism. It should be noted that, if expectations are simply formed by actual experience, there is no useful distinction between the wage norm and credibility hypotheses in their predictions for the present period of disinflation. Both would then require an extended period of low actual inflation, brought about by an extended depression in economic conditions, in order to shift wage inflation downward by more than just the predicted cyclical response. There is no quantitative prediction about how large such an eventual shift down might be. If equations that rely on lagged inflation to capture long-run or expectational effects should overpredict in such a period, it would be evidence of a more favorable outcome than average past behavior would predict. A key assumption underlying the use of rational expectations in macroeconomic models is that agents have enough information about the structure of the economy to make unbiased forecasts of the relevant economic variables. This assumption may be unrealistic during the transition period immediately following a major policy change because agents have not had sufficient time to fully comprehend the implications of the new policy or become convinced of the policymaker’s commitment to maintaining it. Based on this view, we consider the possibility that agents’ forecasts during the transition to lower inflation do not make optimal use of all available information. This set-up can be viewed as a particular form of adaptive (or distributed lag) expectations. Credibility has an important influence on expectations and, therefore, on the dynamics of disinflation. When the central bank enjoys a high degree of prior credibility, rational agents will quickly lower their inflation expectations in response to the announced change in the inflation target. This shift in expectations helps to lower current inflation (via forward-looking wage contracts) and thus contributes to a faster and less costly disinflation episode. In contrast, when prior credibility is low, agents’ expectations respond only gradually as they become convinced of the central bank’s commitment to reducing inflation. In this case, the transition path involves learning and the use of Bayes rule so that rational expectations can display some of the backward-looking characteristics of traditional adaptive expectations. References Chan G. Huh,Kevin J. Lansing, (2000) “Expectations, credibility, and disinflation in a small macroeconomic model”, Journal of Economics and Business, Elsevier. Jones, Charles I. (2014,2018) “Stabilization Policy and The AS/AD Framework” In Macroeconomics. WW Norton and Company. Mankiw, Gregory N. (2010) Macroeconomics, Worth Palgrave Macmillan. Ortega, J. (2019) “Stabilisation Policy: the AS-AD model”, Lecture slides EC5003. Sargent, Thomas J. (2018) “Rational Expectations”, https://www.econlib.org/library/Enc/RationalExpectations.html

statistic 200 lab work: describing data

statistic 200 lab work: describing data.

Show all detail work. Draw map for questions that asked to. I’ve attached an example of what the work should looks like. 3. This question uses the Credit.MTW file in Minitab Express. Data was collected from a sample of 400 adults in the United States. The following information was obtained from each person. Income (in thousands of dollars), Rating (credit score), Cards (# of), Age, Education, Gender, Student, Married, Ethnicity, Balance (on card(s)) These questions will explore describing and summarizing this data set both visually and numerically. A.Let’s take a look at the distribution of income in the sample. Use Minitab Express to construct a histogram for income variable. Copy + paste your graph here. [10 points] B. Describe the shape of your distribution of exercise times from part A. Use statistical terminology. [5 points]C. Use Minitab Express to compute the following descriptive statistics for the Income variable: mean, median, mode, standard deviation, and interquartile range. Type your answers into the table below. [10 points] D. What would be the preferred measure of central tendency for the Income variable? Explain why. [5 points] E. Income under what amount would have a negative z-score in this sample? Explain why. [5 points] F. What type of graph (from lesson 2) would be appropriate to display the Ethnicity variable? Explain why. [5 points] G. Use Minitab Express to make the graph you suggested in part F to display the Ethnicity variable. [10 points] H. Construct a 2-way table for the Ethnicity and Married variables. Copy + paste your graph here.[10 points] I. Use your table in part H to determine which ethnicity had the highest proportion of married people in the sample. Show any calculations and explain your reasoning. [5 points] J. What is the probability of randomly selecting someone from the sample who is married and Asian? Remember to show all of your work. [5 points] K. What is the complement of the probability you found in part J? Compute the probability and explain the meaning in terms of the variables. [5 points]
statistic 200 lab work: describing data

The Spirituality And Architecture Theology Religion Essay

The Spirituality And Architecture Theology Religion Essay. Spirituality is an ultimate or an alleged immaterial reality. The essence of spirituality is the search to know our true selves, to discover the real nature of consciousness. In other words, it is a constant discovery of the incredible, our real self, and a quest of our true being, why we are, who we are and where we belong. This has been a part of the eternal quest of man from times immemorial. These questions have been answered differently by many but are subject to one’s own belief interpretation and perception. Sri Aurobindo in “Indian Spirituality and Life (1919)”says “Man does not arrive immediately at the highest inner elevation and if it were demanded of him at once, he would never arrive there. At first he needs lower supports and stages of ascent, he asks for some line of thought, dogma, worship, image, sign, and symbols, some indulgence and permission of mixed half natural motive on which he can stand while he builds up in him the temple of spirit.”(Sri Aurobindo, Indian Spirituality and Life, 1919) Man’s quest of truth, reality and peace has been unending. Overawed with the infinite nature, whatever he could not comprehend he attributed that to the glory of nature. Man’s intellect cannot accept anything that is unknown, unseen and has no fixed shape or form. Thus to satisfy his intellectual curiosity man gave physical form to the divine being. Spirituality is our attempt to become aware of our spirit. “Spiritual architecture’ refers to any building system that facilitates this awareness. It is, an act of highlighting or bringing forth the self, not by rejecting matter but by manifesting it in matter, at various levels and in multiple forms. E.V. Walter in Placeways, defines spiritual space as … “a specific environment of phenomena that are expected to support the imagination, nourish spiritual experience, and convey spiritual truth” (Walter,E.V., Placeways: A Theory of the Human Environment, 75). Spiritual spaces can be found in nature or they can be a constructed space. A spiritual space found in nature is a place designated by individuals or groups as such a place. It is a distinct space, a place whose character sets it apart from its surroundings. They are distinct from typical or commonly found places. The designation of a place as spiritual comes from the human need to establish a connection with inner truth. A place that is spiritual to one person or group of people may not be spiritual to others. Architecture of a space can invoke all the senses, help one concentrate one’s positive energies to calm a disturbed mind and take a peaceful stable mind beyond the physical. It is an inevitable part of life. It attempts to reflect man’s source and the reason of being in several varied ways. Architecture is more than mere physical shelter or symbolic artefacts. They are catalyst towards our “dwelling”, between our being and the world. Architecture, together with the other arts, has, since time immemorial, been one of the most powerful means to pursue and realize this quest and give it physical-symbolic expression: how to create an identity and a place for our being from within the vast, shapeless and infinite extent of time and space; how to affirm our presences and gain a foothold, in the universe. (Gunter Dittmar, Upon the Earth, Beneath the Sky: The Architecture of Being, DwellingThe Spirituality And Architecture Theology Religion Essay