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Nursing Case Studies

Nursing Case Studies. I need an explanation for this Nursing question to help me study.

. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
3. Consider the discussions and any insights gained from it.
4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.
Critical Thinking Exercises :
Case Study #1: McLanahan University
McLanahan University is an accredited university of approximately 28,000 full-time and 12,000 part-time students, offering baccalaureate, masters, and doctoral programs. It is located in a multicultural city of 1,200,000 inhabitants. There are five acute care hospitals, one of which is a 375-bed magnet hospital. Other health care facilities in the city include three chronic and long-term care agencies, numerous nursing homes, eight home health care agencies, a public health unit, physicians’ and nurse practitioners’ offices, and walk-in clinics.
Dr. Seranous Koupouyro is the director of The McLanahan School of Nursing, which comprises 10 masters-prepared and 11 doctorally-prepared full-time nursing faculty. Faculty have been meeting for four months to redesign the BSN curriculum. Part-time faculty have been regularly invited to join the curriculum work, but their involvement has been slight. The goal is to implement the revised curriculum in 18 months for a class of 125 students.
The Total Faculty group endorsed the existing humanistic-caring, feminist philosophical approaches. Core curriculum concepts, key professional abilities, and principal teaching-learning approaches were identified and the curriculum nucleus endorsed.
The curriculum committee has developed the outcome statements, and after these were approved, they formulated the level competencies. The outcome statements address the provision of evidence-based nursing care in accordance with regulatory standards, effective communication and management, ethical and cultural competence, and advocacy to enhance social justice. The faculty are now ready to consider the curriculum design.

How should the curriculum committee proceed with the work yet to be done?
What should the curriculum committee consider next?
What resources would assist the committee in its curriculum design process?
What should be included in the curriculum design?
How will the curriculum nucleus influence the curriculum design?
How could nursing and non-nursing courses be determined?
What policies should be taken into account for the curriculum design?

Case Study #2: Philmore College
Situated in a small, non-industrial town, Philmore College was originally a “hilltop” college established in 1818 as a school for boys and later, for boys and girls. The school has evolved into a 4-year, privately endowed, non-sectarian, post-secondary institution. Since the 1960’s, programs leading to baccalaureate degrees in psychosocial and physical sciences have been offered. A decision has been made to offer a 12-month accelerated BSN program in response to the nursing shortage and the demand by applicants with prior degrees. This program will be additional to the upper division BSN degree that is currently offered.
The 9 master’s-prepared and 4 PhD full-time nursing faculty have combined nursing practice and teaching experience ranging from 4–18 years. The director, Dr. Agnes Philmore, a direct descendant of the founder, joined Philmore College in 1996. All nursing faculty, including the director, engage in classroom and clinical teaching. The practice experiences for the upper division BSN students are offered in one local 200-bed community hospital, a 224-bed tertiary care hospital in a neighboring city, and a 76-bed long-term and residential care facility. Students also have community nursing experience, which is coordinated and supervised by a primary care nurse practitioner with an adjunct faculty appointment. Approximately 85 students graduate annually and have been consistently successful in the licensure examinations and in obtaining employment.
The director, faculty, several students, and a local nurse practitioner, who comprise the curriculum committee, have been meeting to design the 12-month program. The curriculum nucleus has been determined and the curriculum outcomes written. The principal teaching-learning approaches are focused on active and constructed learning. Courses for the discipline-specific, accelerated 12-month program have been identified. The committee is ready to begin course design.

What parameters must the curriculum committee consider when designing the courses?
In what way will a commitment to active learning influence course design?
Which components should be included in the courses?
What classroom and clinical experiences could be incorporated into the courses?
What would sample clinical and classroom courses look like for this accelerated baccalaureate-nursing program?

Required Textbooks:
Billings, D. M. & J. A. Halstead. (2012). Teaching in nursing: A guide for faculty (4th ed.). St. Louis: Saunders. ISBN: 9781455705511
Keating, S. B. (2011). Curriculum development and evaluation in nursing (2nd ed.). New York: Springer. ISBN: 978-0826107220
Iwasiw, C., Goldenberg, D., & Andrusyszyn, M. (2009). Curriculum development in nursing education (2nd ed.). Boston: Jones & Bartlett. ISBN: 978-0763755959
Nursing Case Studies

Answer Questions in regards to my Argument Essay (VENUS). Help me study for my English class. I’m stuck and don’t understand.

Develop: Audience and Purpose Reflection
Evaluation Title: Audience and Purpose Reflection

Write 3 to 5 well-developed paragraphs and avoid using you/your pronouns.

Use the following questions to get started with the reflection:

Look back on the writing used in your research and the writing you used to present that research to your reader within your Academic Argument Essay.
Think about the structure of the research. Was it all facts, stats, and data or did the writer blend narrative with those facts and stats?
How did you decide to present research to support your claim?
Did you use short, power quotes or long block quotes?
Why do these things matter with an academic audience?
Why is formal writing the language we must use to establish purpose?

Answer Questions in regards to my Argument Essay (VENUS)

Xunzi’s Conceptions of Human Nature Research Paper. Xunzi also known as Xun Kuang was a Chinese philosopher during the China’s classical period. He was one of the Confucian philosophers who were under the reign Emperor Xuan in China. Xunzi made significant contribution to modern philosophy because he contributed to the development of the Hundred Schools of Thought. Among many of his philosophical works is his view of human nature. According to Xunzi, people are evil in nature while their goodness is acquired through training. He states that the nature of human beings is evil from birth and possesses qualities like selfishness, anarchic, and antisocial traits. However, the society shapes and trains an individual to attain moral standards of the society. Furthermore, Xunzi argues that the society achieves this by influencing a person in a positive way. Therefore, the paper analyses the arguments presented by Augustine, Pelagius, and Zhu Xi concerning Xunzi’s view of human nature. According to Augustine, since human beings are not perfect, they are bound to make mistakes and errors. In his philosophical work titled “The City of God,” which explains how the first human beings transgressed in the Garden of Eden. Augustine elaborates the infallible human nature. He asserts that, even after God gave men the freedom to eat any other fruit in the garden and leave the one that was in the center of the garden, they still went ahead to eat the forbidden fruit; hence, making the mistake of disobedience. The “Yahist Legend,” further explains the mistake by presenting an occasion where God tells humans to eat of all the trees, which were pleasing to consume except the tree of life. According to Augustine, human beings have an imperfect nature and are bound to making mistakes. The concept is evident from what Adam and Eve did in the Garden of Eden as they committed the mistake of disobedience, and regretted their actions latter when God questioned them. In addition, Augustine notes that human beings are remorseful. After disobeying God, they became repentant as they hid and covered themselves with stitched leaves from figs. Humans remained subject to God, and thus, they received another chance of redemption through Jesus who is the son of God. However, since actions have repercussions, man and the woman received punishment from God after disobedience. In the Garden of Eden, the Adam and Eve had the freedom to eat of any tree except the tree in the center of the garden. The consequence of disobedience was death. Therefore, the man received a sentence of hard work and death as a punishment for the wrongdoing. Since God is just and merciful, he gave Adam and Eve another chance. Thus, Augustine displays human beings as infallible, remorseful, and ready for corrections. In his letters to Demetrius, Pelagius notes that the reference to the creator is paramount when determining the good human nature. According to Pelagius, people love and admire authority. He further explains this phenomenon by asserting that men marvel at the strong and big animals that are subject to their authority and control. Additionally, human beings love freedom, which was the initial desire of God. In his letters, Pelagius notes that God wanted human to feel free and do what pleased them. However, the level of freedom reduced when humans sinned and disobeyed God. Moreover, in his letters to Demetrius he quotes the book of Deuteronomy where God gave human beings the freedom to choose between life and death. Pelagius also highlights that human beings love appreciation and praise. This is the nature of humankind as presented by Pelagius. Pelagius explains that individuals do not like policies and conventions. He says that people love working in a free environment without rules and regulations. According to Pelagius, humans love engaging in activities voluntarily without undue coercion. In the letters of Demetrius, he gives an account of some people who had a good human nature like Enoch and men who demonstrated bad morals such as Adam and Simeon to discuss the human character and nature. Therefore, Pelagius highlights that the ultimate determinant of good human nature is the creator. He also asserts that humans who have a good nature portray good morals that accrue from the good nature. He further asserts that individuals with good manners sometimes make mistakes because no human being is perfect. Zhu Xi approaches the discussion of human nature using the mind and a river. The scholar asserts that when the river is still or calm, it denotes a composed nature of the individual’s mind. Subsequently, Zhu Xi relates human desires and feelings with waves and flow of water in a river or a lake. According, to Zhu Xi, some waves are bad and torrential whereas others are less likely to cause any harm, as they are mild. These waves reflect the good and bad desires that people express. In the writings, Zhu Xi notes that nature precedes an activity and feelings then succeed. Hence, the mind helps in uniting nature, feelings, and activity when humans undergo through pre-active and post-active states. Moreover, Zhu Xi says that, in many cases bad moral values overrule the good values. In explaining how bad morals destroy good moral values, Zhu Xi used a dam to demonstrate that when the dam bursts it causes extensive destruction. Furthermore, Zhu Xi explains that the mind controls all the operations of an individual whether good or bad. According to Zhu Xi, the mind is a ruler and has the presence of understanding, respect, love, and morality. However, stirred the mind produces feelings like fury, contentment, happiness, and sadness. Therefore, the mind is like the supreme controller of the whole body, and thus, controls the activity of the person. According to Zhu Xi, human nature is subject to the reflexes in the mind, which is the controller of all the activities that an individual performs. Hence, according to Zhu Xi human nature greatly attributes its outcomes to the mind. Thus, Zhu Xi clearly elucidates the nature of human beings and presents the existing diversities. According to Xunzi, human nature is evil and it is only through training that a person can acquire good attributes. In addition, Xunzi notes that from birth, humans display bad qualities like self-centeredness, lawlessness, and antisocial traits. However, through continuous training and molding by the society, a person then acquires moral values and learns to behave in a disciplined manner. Furthermore, Xunzi believes that an individual can acquire and employ moral values and personality traits from the society. The prime objective of acquiring moral values and traits is to override the innate antisocial and evil traits. Xunzi also perceives that a state or a country requires rules and regulations so that it can shape and mold the behavior of an individual, which is evil. In his assertion, Xunzi perceives that since human nature is ugly, absence of state and regulations can render a man uncivilized and wild. Pelagius thought that when determining good human nature it is vital to refer to the supreme creator who is God. He presents that some of the human requirements include love for authority, freedom, and control. In the words of Augustine, human beings are not free from mistakes as they are not perfect. According to Augustine, humans require companionship and authority. He also states that men are erroneous and employs the case of the first humans who disobeyed God by eating the forbidden fruit. On the other hand, Zhu Xi uses a river or a water body to bring to the fore the discussion of human nature. According to Zhu Xi, the mind acts like the controller of human activities and dictates what an individual performs. Thus, Pelagius, Augustine, and Zhu Xi have different thoughts concerning human nature as opposed to Xunzi’s view. While Xunzi states that human nature is bad and evil, Pelagius, Augustine, and Zhu Xi explain that human beings have innate traits that are good, but are not acquired in training as asserted by Xunzi. The research paper focuses on the characteristics that human beings demonstrate. It discusses perceptions of Zhu Xi, Augustine, and Pelagius concerning human nature according to the argument of Xunzi. According to the three individuals, human beings are not perfect, and therefore, they are bound to making mistakes and errors. Pelagius and Augustine use biblical excerpts like that of Adam and Eve to explain the imperfect and remorseful nature of human beings. On the other hand, Zhu Xi relates the human mind to a body of water and discusses human nature using the relationships of human mind and river. Contrarily Xunzi believes that human nature is evil from birth and requires training and control in the evil state so that an individual behaves in a morally upright manner. Xunzi’s Conceptions of Human Nature Research Paper

Online Etiquette in Virtual Learning Environment: Reflection

Online Etiquette in Virtual Learning Environment: Reflection. Netiquette and Student Learning Experience on Blackboard – Reflective essay Communicating by email and other methods on the Internet such as online message boards and chat systems has become very common these days. It is almost impossible to pursue a course of study in higher or further education without using computers, and without communicating with other people online. Yet it can be safely said the most of us have never had any type of formal training in communicating online. The increased use of Virtual Learning Environments such as Blackboard and Moodle put an additional imperative on students to learn how to communicate online. This means that students now not only need to learn the content of the course, they also need to use a new tool properly prior to studying the subject matter. At our University, the Blackboard is used for various courses. Most students today are already familiar with the Internet and have already communicated with others via various methods on the Internet; hence there isn’t a steep learning curve when they learn to use this new tool. Additionally, support is provided in various ways for students who require it. Firstly, students can approach the online learning support officer if they require any general help with the system. Secondly, they can approach the module leader or teacher if they have any problems with any specific course they are taking on Blackboard. Thirdly, they can approach their personal tutor with any problems that cannot be otherwise resolved. Practically, however, students often find peer support invaluable. I always found myself asking or being asked about specific issues with Blackboard. Some of the common questions are about where are the buttons one would require to perform certain tasks, for example the upload button when submitting an assignment, what happens when the system ‘hangs’ – this often creates a lot of anxiety, especially when it happens close to the deadline for the submission of an assignment! I have often found that the people who are able to readily answer these questions have often faced the same problem themselves, and found it out either by trial and error on their own, or were in turn helped by some others. Although technology is often (dis)credited as the cause of an increasing loss of personal contact in every aspect of modern life, ironically, the use of an unfamiliar tool such as the Blackboard actually helped me communicate better with some other students, as we faced a shared problem and being compatriots somehow brought us closer. Netiquette was something I decided that I had to learn before I was ‘brave’ enough to add my comment in the discussion forums. This was mainly because I was very used to the ‘Internet slang’ of using the short form of words such as CUL8R and I wasn’t very sure these would be acceptable and did not want to get on the wrong side of the lecturer unnecessarily. I did some reading on the topic and found a great deal of material on the Internet regarding Netiquette. In particular, I read the RFC 1855 (Hambridge, 1995), which was a sort of bible on netiquette. On reading it the reasons behind many of netiquette rules that I didn’t think were important, most of it seemed to be common sense and polite. The WIRED article by Leahy (2006) cited one good example of an email communication that had this sentence “Don’t’ work too hard”, which could be interpreted in a variety of ways – had this been addressed to me, I would have wondered, was the writer sarcastically implying that I was working too hard, perhaps trying to impress someone, in which case I probably would have taken offence, or was it just a joke? Either way, it’s difficult to interpret. I read the general rules for posting on Blackboard and saw that they weren’t very different from the RFC 1855. There were only minor differences, some recommendations adapted to keep in view that this was an educational discussion board in an educational institution. Going back to my interaction on Blackboard, I monitored the comments on the discussion board for while before I decided to post a somewhat inconsequential comment to test the waters. I had given a great deal of thought before deciding to participate in the discussion online. Initially, I thought that since participating in the online discussion forum wasn’t compulsory, I need not participate; it would only take me more time to learn the rules, and then engage in a discussion that didn’t really earn me any marks in my final score for the module. However, I spoke to some of my peers, and got the view that participating in discussions not only helped you clear your doubts, it also helped others; most often, someone else had the same question, but was just too scared to post it, and when you did, they were grateful to you; sometimes that made them bolder to start posting too. Then, one of the lecturers for one of the modules that was using Blackboard encouraged us to continue a discussion that took place in class online, and that was what spurred me on to leave me comment; however, having thought out my first post for very long before posting it, I feel that I somehow ‘killed’ it and it had the desired effect: it was so inconsequential, no one posted a reply to it. Funnily, I found this was somewhat disheartening, however, resolved to take part in the discussions better and managed to follow through. The main benefit I obtained from the discussion boards is that if there are some strands of thought running on your mind about a topic that is being discussed, the discussion board offers you the opportunity to actually post those thoughts anytime, anywhere. On hindsight, communicating on the Blackboard discussion board did not have very different rules from communicating face to face in the classroom. One just has to remember that when posting on an online forum, the readers cannot see your face to gauge your expression and therefore are more likely to misinterpret your statements. Using ’emoticons’, if these are acceptable, can help convey the tone of the message to a certain extent. Also, if you are always prepared to offer a clarification and apology if necessary if your message has been misinterpreted then you cannot go very much wrong. There are indeed some excellent positives to the use of Blackboard (or any other Virtual Leaning Environment) in the university. The use of the VLE allowed us to work at home (or as a group in one person’s home) and enabled us to avoid spending the time travelling to university, and also the stress. We were able to discuss group assignments at a place convenient to the entire group, and as for individual assignments, there is a great deal to be said for sitting on one’s own room with a pizza and coke and typing up an assignment. While it took some getting used to, once I got used to the system, I greatly appreciated the availability of all the information that was made available on an anytime, anywhere basis. However, I think that I would not like to pursue course of study that was conducted wholly through the VLE. This is because I felt that the face to face interaction I had with the lecturers of most modules was important, even if it consisted of me simply sitting passively in class listening to the lecture. This is because I felt I could understand much more when it was the lecturer explaining a certain point in person, not reading the written word; additionally, during face to face interaction, I had the opportunity of clearing any doubts that popped into my mind, and one once occasion, the teacher drew a simple diagram which allowed me to grasp the concept quickly; this would not have been possible if we were discussing the topic on the discussion forum on Blackboard. If all the convenience of using a VLE in additional to face to face teaching can be made available in a cost-efficient circumstance, then I would definitely recommend the use of Virtual Learning Environments. As for discussions on Blackboard, with my experience, I am now a bit confident at posting my comments on discussion topics. Perhaps the next semester I may even be bold enough to start up discussion on new topics if the opportunity presents itself. References Hambridge, S. (1995) RFC1855: Netiquette Guidelines (Available online at – last accessed Aug 2007) Leahy, S. (2006) The Secret Cause of Flame Wars Wired (Available online at – last accessed Aug 2007) Online Etiquette in Virtual Learning Environment: Reflection

Psychological Impact of Video Games

essay helper free Psychological Impact of Video Games. Introduction One of the crucial issues that happening in this decade is that games become popular among all stages of people such as children, teenager and adult. Video games have become one of the favorite activities of children in America and school children have been affected significantly (Dewitt, 1993 cited in Gentile, Lynch, Linder,Psychological Impact of Video Games

Anaesthetic care

Share this: Facebook Twitter Reddit LinkedIn WhatsApp In the following text I the author will provide an account of the anaesthetic care given to a paediatric patient in my care during a surgical procedure to repair her cleft palate. I will discuss the rationale behind the chosen anaesthetic technique and will analyse why the method was identified as the most suitable backing the findings up with related literature. The text will explore the care given to the patient and the preparation needed to ensure a safe procedure starting from the pre-assessment visit right to the anaesthetic room looking at the roles of some of the multi disciplinary team members involved in the child’s care. An episode of care for any individual patient is a complex series of interactions that make up the process of care. The recipient of this anaesthetic care is an 8-month-old female, who, as patient confidentiality forbids the use of her real name (NMC 2002a) shall be known as Eve. Eve was born at 41 weeks gestation, during a routine prenatal scan at 23 weeks gestation an abnormality of her facial structure was noted, her parents were informed of this and counselling and advice was offered. The extent of the abnormality was not seen until Eve was born. She was born with a unilateral cleft lip and palate, which is were there is a single cleft of the lip, and the hard, and soft palate are also divided (Shprintzen and Bardach 1995) but was otherwise fit and well. In accordance to Watson et al 2001 clefts of the lip and palate may be isolated deformities or may be a part of a syndrome. Eve has not been diagnosed with a syndrome there for this is an isolated deformity. Watson (2001) suggests that non-syndromic clefts are multi-factorial in origin and could occur due to gene involvement, various environmental factors or embryo development in relation the mothers life choices during pregnancy i.e. excessive alcohol, drug abuse etc. Eve had previously undergone the first stage of the surgery, which was a repair to her cleft lip. This is done between the ages of two and four months within our trust. This is mainly due to cosmetic reasons but also to encourage oral feeding and sucking and to encourage the tissues to grow at the same rate as the child’s facial structure (Watson Et al, 2001). Eve was admitted to hospital the day prior to her surgery. Eve’s mother had requested this rather than attending pre-admission clinic as she had problems with transportation to the hospital. This highlights good communication (Department of Health, 2003) between the nursing staff and Eve’s mother, which is of benefit to both the child and the family’s needs (Clayton, 2000). The Department of Health (1989) states that the welfare of the child is paramount, however Smith and Daughtrey (2000) believe that it is also important to ensure that parental needs are also met. Wong (1999), states that good family centred care is considerate of all family members’ needs and not only the needs of the child. The initial assessment of Eve involved her primary nurse, Eve and her mother Joanne. The cleft palate pathway was used as assessment aid and highlighted any needs that Eve and her family had. The anaesthetist (Dr A) then examined Eve and was able to explain the procedure to Eve’s mother. This meeting with Dr A provided Eve’s mother with both verbal and written information therefore equipping the family with knowledge and support (Summerton, 1998). During Dr A’s visit she was able to assess Eve’s physical and mental condition ensuring that it would be safe to administer a general anaesthetic. During this assessment Dr A was able to request that routine blood samples were taken including cross match in case Eve should need a blood transfusion due to high blood loss during the procedure. She was able to read the operation notes from Eve’s previous visit making notes of the ET tube size used, the analgesia given, there amounts and if they had the given effects on Eve’s pain relief and do an assessment of Eve’s airway. Dr A was aware that Eve would have a difficult airway due to her cleft palate and the fact that her mother reports of her snoring whilst asleep, however she is also aware that assessment of this can be difficult due to Eve being uncooperative or asleep and that most tests used in adult practice including the mallampati scoring system are not validated for use in the paediatric population and are not really useful in the younger child (Sumner and Hatch, 1999). She was able to discuss the proposed anaesthetic and pain relief techniques and pre warn eves mother about the monitoring that she may see being used on eve in both the anaesthetic and recovery rooms. Dr A also discussed the use of premeditation such as madazalam with Joanne, it was decided that Eve would not have this as rendering her semi or fully unconscious with a respiratory depressant drug can become hazardous due to Eve’s cleft palate as her tongue may fall backwards and obstruct her already compromised airway (Sasada, M and Smith, S.2003). All information obtained during the pre assessment by Dr A should and was relayed to the operation department practioner (ODP) who was working alongside her during the case, ensuring that all equipment needed was readily available as and when needed. As Morton (1997) states the motto “Be Prepared” is a very important principle in anaesthesia. If things were to go wrong during the anaesthesia, intervention must be immediate to avoid harm to the patient; therefore preparation and the checking of equipment and drugs are vital. At the start of each case careful attention to detail is required when setting up the work area. The anaesthetic machine both in the anaesthetic room and in side theatre must be checked in accordance with The Association of Anaesthetists guidelines (Appendix 1) and the manufactures guidelines, and all equipment required must be gathered. There seems to be no set guidelines stating the exact equipment needed so the anaesthetist and the ODP must work together and decide for themselves what they need. “The success of a paediatric procedure depends not only on the skill and knowledge of the anaesthetist, but also on the possession and utilisation of the proper equipment” (Bell.1991.pg81) Bell (1991) offers the Pre-Anaesthesia Checklist: SCOMLADI that may help towards the selection of equipment: SCOMLADI is a mnemonic for Suction Circuit Oxygen Monitors Laryngoscope – handle and blades Airway – oral, nasal, ETT, /- LMA Drugs: Intravenous – drips (Bell, 1991.) In Eve’s case the pieces of equipment that were made available were: – Suction, this can be a vital piece of equipment during anaesthesia. This is due to the fact that it can remove gubbings that may cause airway obstruction quickly ensuring the safety of the unconscious patient, although great care must be taken when using suction on an oral wound to ensure no further damage or trauma to the repaired area (Stoddart and Lauder, 2004) Circuit, the Jackson Rees modification of the Ayres t-piece is the main choice as it was designing for paediatric use and it is said to decrease the resistance to breathing by eliminating valves and decreases the amount of dead space in the circuit. Oxygen, this is readily available on the anaesthetic machine. The oxygen is delivered to the machine via a pipeline from the hospital stores. There must also be a full cylinder on the machine for use in case of a malfunction of the pipeline supply. This must be checked during the machine check. Monitors and monitoring aids. Some of the important aids are: Pulse oximeter, this gives a continuous reading of the oxygen saturation in the blood via a fingertip sensor. Although extremely reliable the probes may not pick up a good trace if the patient is cold of has a poor peripheral perfusion. ECG, This provides us with the information of the heart rate and rhythm. This is a valuable aid in detecting bradycardia and arrhythmias in paediatric patients. Blood pressure (bp), the most common way to measure Bp is by using a cuff this is known as non-invasive. Parameters are set on the monitoring console to enable the cuff to inflate and record the patient’s blood pressure at regular intervals. Arterial Bp can be measured via a cannula placed in an artery, which attaches to a transducer, this is known as invasive monitoring and can give continuous readings. In Eve’s case a cuff was used in accordance to Dr A’s wishes. Capnography This is attached to the breathing circuit and analyses the gas mixture. The monitor displays the concentration of oxygen, nitrous oxide, carbon dioxide and volatile agents. This information is useful for assessing the adequacy in ventilation and the depth of anaesthesia. The presence of carbon dioxide on the reading confirms that the ET tube is in the right place (Morton, 1997). Temperature Infants lose heat very quickly and there ability to maintain their own temperature is blocked by the anaesthetic (Kumar, 1998). A naso/oesophageal probe is placed in Eve’s nostril instead of her mouth, as that is where the surgery is taking place. There is other methods of monitoring available such as blood gases, central venous pressure, neuro muscular transmission etc but in Eves case these would only be used if Dr A requested them. Laryngoscope and blade, the different choices of blades are due to the variation in the anatomy found in small infants and children, this is due to the fact that a child’s larynx lies higher and more interiorly in the neck and there epiglottis is longer and thinner than adults (Watson, 2001). The use of different size and shape blades is down to the anaesthetist’s personal choice Dr A prefers to use a lateral approach with a straight blade such as a Magill (Morton.1997). Dr A also likes to have a piece of rolled up gauze filling the cleft to ensure that the blade does not get caught in the deep cleft. The difficult intubations trolley is also essential this is because there is a large selection of different blades, handles, bougies and airway’s such as cut/uncut endotracheal tubes, guidell airways, laryngeal masks and face masks which are all available on hand. Airways, A selection of pre-formed south facing, uncut and reinforced endotracheal tubes. The size of which can be calculated by using a formula (age / 4 4.5 = estimated tube size) or by the child’s weight (Morton, 1997). Eve should take a 4.0mm tube but it was noted on her last anaesthetic sheet that a 3.5mm tube was used with a gauze pack insitu due to her different anatomy. Drugs, There are many different types of anaesthetic drugs available such as Volatile induction agents (Gas), Intravenous induction agents, muscle relaxants, reversal agents, anti emetics, local anaesthesia and analgesics. All of which have the own pros and cons for using them. Dr A has chosen to use the volatile agent Sevoflurane in order to initially anaesthetise Eve this is due to the fact that Eve’s Venous access is poor due to her being a “podgy” baby. Sevoflurane is the least pungent and irritant of the volatiles and rivals many of the other inhalation induction agents for children. Eve was induced with oxygen, nitrous oxide and 8% sevoflurane, her airway was difficult to maintain due to her tongue being large in relation to her oral cavity which is normal in infants (Wong, 1999) therefore a size 1 guedel airway was used in order to keep the tongue from causing an obstruction. Anaesthesia was maintained with oxygen, nitrous oxide and isoflurane another of the volatile agents also used within paediatrics with the feeling that this is mainly due to the low cost. Eve also had an infusion of the opioid remi-fentinal. Intra-Venous (IV), IV access was gained when an adequate depth of anaesthesia was reached and endoteacheal intubation was achieved. In total four IV lines were inserted, one to administer IV drugs such as anti emetics, anti biotics and IV pain relief etc. another for the IV infusion of Remi fentinal pain relief. Another for the maintenance fluids and the last on as a spare of to use if blood products are needed. Fluid therapy is important in both adults and children due to the fact that they have been nil by mouth for many hours before there procedure in accordance to hospital guidelines. IV fluids are given as maintenance to preserve hydration, to compensate fluid/electrolyte defects as a result of fasting and also to replace ongoing loss due to evaporation and surgical bleeding (Wong, 1999). As well as the preparation of the anaesthetic room the ODP must also ensure that all equipment needed inside theatre and during the procedure is available such as an operating table that is in good working order, a cleft palate mattress to ensure the correct positioning of Eve, a warming blanket to ensure temperature maintenance and a jelly mat to protect from pressure area sores (Kumar, 1998). It is also the ODP’s responsibility along with Dr A to ensure that Eve is transferred in to theatre and on the to operating table safely, that all monitoring equipment is transferred to the inside machines and that all IV therapy equipment is connected before the surgeon preps and drapes the patient as this helps towards maintaining the sterile field around the patient. Throughout the surgery it is seen as best practice for the ODP to remain within close proximity to the patient and anaesthetist in case there is a problem (Kumar, 1998), one such problem noted in Eve’s case was that when the surgeon inserted the gag needed to keep Eve’s mouth open he unintentionally moved the position of the ET tube causing a drop in her O2 saturations. Dr A listened to Eve’s chest with a stethoscope whilst hand ventilating her, this enable her to reposition the ET tube back in to the correct position. Once back in the right place more tape was applied, and the tube was fastened in more securely. If Dr A was unable to just reposition the tube she would have had to remove the tube and reintubate Eve, this means that she would have needed a new Et tube the laryngoscope and blade, maybe a face mask in order to pre oxygenate before re intubation. This is the main reason why all intubation equipment used in the anaesthetic room must follow with the patient into theatre. Whilst in theatre a mechanical ventilator is use in order to ventilate Eve. The Newfield 200 is the vent used within this trust it works by intermittently occluding the expiratory limb of the t-piece and is able to compensate for any leaks around the tube. The ventilator can be adjusted in accordance to Dr A’s request meeting Eve’s needs by changing the pressures and times needed. Ventilation was once carried out purely by squeezing the bag by hand; leaving the anaesthetist with just one hand to do other important things such as administer medication or record information, meaning that the Newfield 200 is the preferred method of ventilation in recent times (Sumner and Hatch, 1999). Following the procedure Dr A stopped the infusion of Remi Fentinal and turned off the volatile gas this was to help with the waking up procedure and the safe extubation of Eve. Dr A also ensured that the pack inserted at the beginning was removed safely without causing trauma. Extubation should take place when the patient is fully conscious with there protective reflexes fully intact (Sumner and Hatch, 1999), this is even more important in Eve’s case due to the nature of her surgery as there could be excessive bleeding or oedema due to the trauma of the oral surgery causing more obstruction to her airway. Although suction should be available during extubation it is noted that large suction catheters such as a yanker should not be used and suction kept to a minimum this is to lower the risk of airway obstruction caused by trauma or by disruption of the surgical repair site. Eve’s was extubated safely and was transferred to the recovery room with out the need of ICU or HDU intervention. There she was given o2 and monitored by trained recovery staff until they were satisfied that she was able to maintain her own airway and o2 saturations, there was no or minimal blood loss from the wound site and she was pain free. Dr A had prescribed Eve with analgesics to be given back on the ward if needed, this was to ensure that she had a pain free recovery preventing her from getting upset and crying which can encourage the healing process of the wound and maintaining her patient airway. The process of Eve’s anaesthetic ran a smooth cause. She remained safe throughout the procedure. Great care and planning by both Dr A and the ODP ensured that all events that may have occurred were well prepared for. Share this: Facebook Twitter Reddit LinkedIn WhatsApp

Academic Performance of International Students – Problems

Gaw, K. F. (2000). Reverse culture shock in students returning from overseas. International Journal of Intercultural Relations, 24(1), 83-104. Retrieved from Personal and academic challenges faced by the international student in Australia Abstract: This research study aims to determine the problems faced by an international student resulting in poor academic performances and also some of the factors that are responsible for the weakness in their study of Kings own Institute (KOI) Sydney. Being new to the abroad learning experiences,students certainly will face many challenges interms of their academic and personal life. Therefore,it will try to identify the problems behind the failures,which not only reduce their grades, but also creates problems in their personal and economic life too. The purpose of this study is to understand the learning experience of international students in this new learning environment. New culture, differences in the learning style, not knowing the proper ways of doing the class assignments,difficulties on managing the job schedule and management of class,difficulties in discourse, the difficulties on language problem further creates a difficulty of adjustment in the new environment. International students from different countries at KOI makes valuable contribution of cultural and language diversity,but at the same time it creates cultural and language differences among student to another student and student with the lecturer and other staff member of the KOI. When student encounter new environment with unfamiliar face,certainly they feel awkward and shy to ask anything or anyone for help which further becomes problematic for them. Hence; the research will look at how things from the new environment are perceived by international students. The consequences of the research will not only be in finding the problems and its causes but also in finding the proper and positive ways to improve and resolve the existing problems and to lessen them somehow by finding out the causes behind the issue. What are the major issues that international students have to face? When they are newcomers in Australia will be the focus question for research. The significance of the study will benefit both the staff member and the future international students who will encounter similar problems at an early phase of starting new abroad experience away from their home. These issues and problems can help the department of KOI to try for more progressive ways to help out and solve the issues of students who are totally lost and confused. Qualitative research method was used for this research project where face to face interviews to try to understand the issues was conducted with the participants. Five international student from different nationality were taken as the respondent for the research interview and questions. Even though the research has its own significance,scope,aims and objectives,the research had some limitation which was unavoided. Because of the limited time and few respondents . The study would have been more authentic if larger group of people from diverse background and disciplines were interviewed to explore more things and see the comparability. The findings of the study showed other challenges apart from language barrier ranging from time management,adopting the Australian culture,the proper ways of doing the assignment without plaigairism and proper referencing of the source,accommodation,social isolation,and financial complication. In addition,the interview question with the international students highlighted how educational workshops,help from friend and colleagues,and individual study improved their difficulties and challenges and turn into a better experience of the new learning environment. All in all, the study will try to understand the views and the opinions of the various participants and try to resolve the issues by comparing and contrasting the problems faced by each participant and also will look at the experiences of the students on their journey of being an overseas student in a different country with different ways of learning. KEYWORDS: Determine, consequences, conducted, resolve, qualitative method, contrasting. The research problem: Studying aboard is a challenging thing for students interms of being able to adjust in every thing that will make things difficult in a new learning environment. The basic purpose of this research will be to seek out the various factors that cause problems for leading to academic failures and also in personal life at King’s Own Institute, Sydney. This research aims to investigate the factors that cause stressful situations for students resulting in poor academic performance and various other issues affecting their lives adversely. Most of the international students are from a second language background, which does not include learning in their first language. Even though they have to take some proficiency test (IELTS) in order to meet the entry criteria to the University and campus, they will have a hard time accessing the resources and also in understanding the lectures because of the new information in the new language too. The main complication faced by the international students is regarded with language and skills needed for academic reading and writing. (Ballard, B.