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Imagine a saffron-colored robed Buddhist monk grooving to loud music being played by lanky, curly haired teenage boys in a dark basement in Brooklyn. This image is one of the many that describes the various extremes in my life.
My name is Nimesha and I’m a Sri Lankan-American who loves free samples and watches old SNL skits. The best thing my parents have done for me right after giving me life was raising me in New York City. This city has given me the freedom to express my true personality while still letting my heritage flow through my everyday life.

Deep in the enclaves of the Lower East Side, I’m surrounded by raggedy teen hipsters, who after chain smoking a cigarette for 15 minutes, sway and jump and shake to music that can be described as a thousand Gameboys playing at once. Oh, how one can smell the teen angst in the air. It’s during times like this when I do not think twice about my parent’s insistence on me coming home early or studying for math class. The noise continues to play and I’m in the crowd. Jumping. Screaming.

Praying. I am now sitting cross legged on a saffron colored pillow on the top floor of the Buddhist Vihara in Queens that I have been attending for the past 17 years of my life. The monks are lined up against the wall and everyone is facing towards the humongous Buddha statue in front of the room. With my eyes closed, I begin to chant. My religion brings out another side of me, a more somber, mindful being, who probably would be more articulate in other situations, if always as relaxed.

Things that stress me out include math, boys and my lovely parents. No really, they are quite lovely! Though we do get into our squabbles, I am starting to understand where they are coming from. I used to disparage their insistence on my studying harder and staying home. But now I’ve realized how much they sacrificed for me to receive an excellent education and a wonderful American life, all due to a recent immigration court case.

My parents missed their mothers’ funeral just so there was no risk of re-entering the US so I could stay at HSMSE and I only got a 70 in my math class that term. They have not seen their siblings in over 30 years yet I sometimes miss homework and warm the soccer bench. This reality occurred to me after my mother’s immigration interview. Since then, my perspective of my life is different. I’ve have had amazing experiences in my life that would never have happened if my parents had not wanted to stay in America to badly.

I have the right to free speech and the right to participate in my government. I have the opportunity to go from living in a two bedroom, one floor apartment to living in the White House. I can even crowd surf one night, and offer flowers in a Buddhist temple the next! My New York is even different now. I don’t just see leather leggings and Nike Dunks as a representation of my adolescence. Instead of focusing on the nightlife, I now appreciate that I am emerged in a wonderful community of cultural diffusion. My New York has become a mosaic. As the saying goes, “my grocer is Korean, my deli man is Israeli, my laundry guy is Chinese, my favorite diner owner is Greek and my favorite falafel guy is Egyptian.” This diversity is what I’ve grown up with and learned from. I see the beauty in this open-mindedness and I embrace it. In fact I see it as an important tool in my interests for my future. Though I have not always made the best choices, like not trying as hard as I could in school, now I am fully ready to seize the opportunities my parents have made possible to me.

My passion for International Relations makes me want to find the best college program and work my hardest at it. My recent realization is a huge motivation to help me succeed in a challenging academic environment. I want to be able to add the tolerance, mindfulness and optimism I have learned from my experiences to the communities I will join in the future, whether it is my college community or the international community as a future humanitarian or politician. For now, I am living my life vivaciously with the knowledge that I myself am a mosaic. I am a product of global, modern, traditional, intellectual and compassionate influences. I am looking forward to bringing the best of the different aspects of me to wherever I go in life.

Using the Nanda 2015-2017 Nursing diagnosis definition and classification list.

Using the Nanda 2015-2017 Nursing diagnosis definition and classification list..

Paul Smith is married and has 2 children. DOB 14/5/1976.  He presented to the emergency department post ongoing abdominal pain with rebound tenderness. He has a history of hypercholesterolemia, heart murmur, smokes 15-20 cigarettes a day and drinks 3 beers daily. He lives on a farm 20km away from the hospital. He has been reviewed by the Surgeon and has been admitted to your ward for an Emergency Laparoscopic Appendectomy today. Please use intext referencing and reference Australian references only.

You have commenced your shift.  You are required to read all of the documentation in Paul Smiths case file including: Nursing history and assessment form, Appendectomy clinical pathway, Pre-anaesthetic checklist (attached) And to complete the following tasks in consultation with the RN/assessor.

Question 1:  Using the Nanda 2015-2017 Nursing diagnosis definition and classification list. (please see attached) Identify 1 actual and 2 potential (3 in total) nursing diagnoses using the domains of Nanda as listed below. Per each heading:

DOMAIN 3 – ELIMINATION AND EXCHANGE

DOMAIN 11 – SAFETY PROTECTION

DOMAIN 12 – COMFORT

Question 2: Using the information located on the Surgical Appendectomy Clinical pathway (MR107) and other documentation in Pauls file, such as the Nursing History and assessment form, complete the Country Health SA Patient care plan (MR-PCP) pages 2 and 4.

a)      Page 2 – Under the heading Fundamentals of Care you are to identify and document the care needs required for Paul Smith Day 0 (preoperative) and include any interventions/diagnostic tests identified on the clinical pathway. (Document under other patient requirements)

b)      Page 4 – Complete the dignity/respect/privacy, personal needs, psychological/social and environment requirement for Paul’s admission.

c)      Using the information you have completed on the Surgical Appendectomy clinical pathway (MR107) and other documentation in Paul’s file such as the Nursing History and Assessment and the Country Health SA patient care plan (MR-PCP:

 Identify 3 nursing interventions that you will undertake pre-operatively for Paul this shift.

Question 3: Explain the pathophysiology of Pauls presenting condition to Pauls wife, include clinical manifestations. (100 words) (You have already gained Pauls permission to share this information.)

Question 4: Paul has concerns about how he will care for himself immediately post operatively from the laparoscopic appendectomy. He asks you to explain the sorts of activities he will and won’t be able to undertake. Explain to Paul… 1 example of how the appendectomy may impact his ADLS (activities of daily living) /physical activities and how he can manage that example and

identify 1 psychological consideration that Paul may experience immediately post-surgery and a strategy to manage that consideration.

Question 5: You are to give Paul education on postoperative complications that he is most likely to experience due to his surgery. Identify from the list the two (2) most likely postoperative complications. Hypovolemic shock / Haemorrhage /Thrombophlebitis/Pneumonia

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