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Nursing Process of Transurethral

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Share this: Facebook Twitter Reddit LinkedIn WhatsApp Introduction It’s said one knows not what he has until it is gone, This common proverb can be applied to the processes involved with Transurethral resection of the prostate( TURP). TURP is done to treat or alleviate “enlargement of the prostate gland (benign prostatic hyperplasia)” (mayoclinic.com, 1). The prostate is situated near the urinary bladder in an adult male. When a person urinates, urine flows from the bladder, through the prostate gland, then the urethra which is enclosed within the penile shaft, leading to the destination. When this process is interrupted, in this case by an enlarged prostate gland blocking the exit out of the bladder; it can cause various urinary tract symptoms. These symptoms can vary from difficulty urinating, to urinary urgency, nocturia, oliguria, urinary retention and others. If these symptoms are intense, a TURP procedure is recommended by the physician as a minimally invasive method of alleviating them Nursing Process of Transurethral Resection of the prostate It’s said one knows not what he has until it is gone, This common proverb can be applied to the processes involved with Transurethral resection of the prostate( TURP). TURP is done to treat or alleviate “enlargement of the prostate gland (benign prostatic hyperplasia)” (mayoclinic.com, 1). The prostate is situated near the urinary bladder in an adult male. When a person urinates, urine flows from the bladder, through the prostate gland, then the urethra which is enclosed within the penile shaft, leading to the destination. When this process is interrupted, in this case by an enlarged prostate gland blocking the exit out of the bladder; it can cause various urinary tract symptoms. These symptoms can vary from difficulty urinating, to urinary urgency, nocturia, oliguria, urinary retention and others. If these symptoms are intense, a TURP procedure is recommended by the physician as a minimally invasive method of alleviating them. One does not think of what it entails to actually be able to get the urge to urinate and do so with ease. The pleasure of this almost automatic process has been taken away from clients with benign prostatic hyperplasia, leading to the need for a TURP. This explains the concepts of “not knowing what one has till it’s gone” or severely made problematic. A nurse comes into play in this process by using the nursing process of assessment, nursing diagnosis, goals, intervention and evaluation to manage the client through the entire course of treatment. That is the nurse follows the patient from preoperative to Post operative while diligently providing care and teaching. Preventing complications of TURP post operatively is a major part of the procedure, as this determines the success of such procedure. In reference to complication after TURP, Weaver 2001 stated that “prevention must start long before the patient is admitted into the hospital” (p. 1). The nurse needs to ask if the patient recently took Coumadin, Aspirin or any NSAIDs few days before the procedure. These drugs affects blood coagulation and they must have being stopped several days ago before to prevent hemorrhage. Weaver further explained that Coumadin should be discontinued 3-7 days before TURP and patient must have stop taking Aspirin for at least 10 days before (p. 1). During postoperative care, the nurse needs to assess the patient’s indwelling catheter for patency continuously. The content of the bag must also be checked. This is because “a change in the urine color and consistency is the first clue to active bleeding.”(Weaver 2001, p. 2) The patient’s vital signs need to be checked at regular intervals to detect any changes which could be related to bleeding and infection. Particular attention need to place on the patient’s laboratory values because a low white blood cell count could also show sign for infection. The patient’s input and output must also be assessed due to the continuous bladder irrigation (CBI). After the removal of the catheter, the nurse should assess the patient’s urine and explain to the patient that some tingling or burning might be felt and that this is normal. Gilhurst (2006) notes that TURP “…is used for approximately 90% of prostate surgery and that it is considered the ‘gold standard'”. Although TURP is such a high quality procedure, it is not without its risks. Nurses need to diagnose quickly to prevent further complications or mortality in patients. With this invasive procedure, along with catherization, patients are at high risk for infection. Fluid volume defect, as a result of hemorrhage, is another major diagnosis of concern. Patients doing this procedure would usually exhibit disturbed body image and knowledge deficit, although this varies by individual. The expected goals for TURP are that the patient would not experience TURP syndrome, the patient would not exhibit signs of hemorrhage, the catheter’s patency would be maintained without complication, the patient would verbalizes an understanding of the procedure and its desirable / undesirable effect. The nurse should ensure that the patient receives thorough discharge teaching. According to Ng (2004) “continuous bladder irrigation (CBI) is an established procedure designed to prevent the formation and retention of blood clots following transurethral prostatectomy (TURP).” (p . 97). This continuous irrigation is established by the use of a three-way Foley catheter. The nurse is responsible for the management of the Foley catheter’s patency. To ensure that patency is maintained, continuous assessment and early detection is implemented. It is the nurse’s duty to assess the saline irrigations height, volume remaining, and fluid level in the drip chamber. An assessment of the drainage bag for the amount, consistency and the color of the drainage is a necessary intervention in assuring efficiency of the procedure and in alerting to the development of any complications. Ng 2004 listed a few other interventions in the maintaining of catheter patency which include “assess for kinking, traction, and leakage; adjust the clamps to ensure continuous flow rate; and continuously check fluid balance/ bladder irrigation.” (p . 98). After a thorough assessment, if blockage is suspected the nurse is to intervene. As stated by Ng 2004 to unblock the catheter the nurse’s intervention should be to, “reassure the patient and explain the procedure, turn off the bladder irrigation system; milk the tubing; observe drainage; and assess for a decrease in the patient’s level of discomfort.” (p . 101). “The most common complication after TURP is hemorrhage”, with this in mind the nursing interventions should include checking the patient’s vital sign monitoring every four hours (Wasson 2004, p . 5). The color and consistency of the urine should also be checked at two hours interval. “Instruct the patient to remain flat or at a slight incline immediately post-operatively, because sitting may increase venous and bladder pressure causing bleeding,” (Wasson 2004, p . 5). While in the hospital, the nurse should inform the physician if there is an increase in the rate of bleeding, and of any drastic change in vital signs. Hypovolemia is a risk factor of extensive bleeding and the nurse should be prepared to intervene with replacements of intravenous fluids and blood products. According to Wasson 2004, the nurse should “instruct the patient to drink at least 12 glasses of water per day and to avoid the use of alcohol, caffeinated beverages, and spicy foods that may over-stimulate the bladder” (p . 5). Another serious TURP related complication is known as TURP syndrome” (Wasson 2004, p. 4). TURP syndrome is described to be “an abnormal vascular absorption of irrigating fluid during surgery which causes severe dilutional hyponatemia and hypervolemia” (Wasson 2004, p . 4). Nursing interventions aimed at preventing TURP syndrome include careful assessment of its symptoms which include; bradycardia, confusion, full bonding pulses, dramatic increase in blood pressure, tachypnea, and temporary blindness. Discharge teaching is important in making certain that TURP is efficient in resolving the patient’s condition. The patient should be advised to keep a log of voiding and record the volume of urine, its characteristics, and the frequency. Strenuous activities such as climbing stairs should be avoided during the first few weeks after discharge. The patient should also be encouraged to rest regularly for approximately two to six weeks; this promotes healing of the surgical site. Activity restrictions that enables healing also includes, avoidance of lifting items weighing over five pounds, avoidance of excessive physical exertion, and long walks. Conclusion The patient should be taught by the nurse to notify the physician, if bleeding occurs and does not stop within one hour of therapy. A high fiber diet is encouraged during discharge teaching making sure to emphasize that his helps prevent constipation. Also thorough perineal hygiene should be stressed and the patient should be taught that it reduces the risk for infection. Patients should be advised to take antibiotics and any other medication as prescribed by the physician. Teaching kegal exercises is another important nursing intervention as it strengthens the pelvic floor muscles. After the intervention, the nurse will do an evaluation in order to find out if the goal has been achieved and to see if the patient is progressing as planned. The nurse should reassess the patient to ensure that he or she did not experience TURP syndrome, hemorrhage and any other complications previously mentioned. The effectiveness of the patient teaching should be reassessed, the more knowledgeable the patient is about steps to be taken, the greater the probability that the patient will comply. This may help the patient in taking proper care of themselves after discharge and also prevent complications. Therefore, nursing intervention always help the patient to get positive outcomes. (Wasson 2003, p. 12) As with the fore mentioned proverb, having the need or feeling of urinating, or even the ability to go to the bathroom and successfully relieve the pressure created by a full bladder is a gift. A gift that when gone or almost gone as with oliguria or anuria, and then regained with TURP one would realize it value, and develop a brand new appreciation for the process Share this: Facebook Twitter Reddit LinkedIn WhatsApp

ECON 201 SEU When Taxes Induce People to Change Their Behavior Case Study

ECON 201 SEU When Taxes Induce People to Change Their Behavior Case Study.

Assignment 2-Case Study-Chapters: 7, 8, 9 & 12 : – [5 Marks] Case Study When taxes induce people to change their behavior—such as inducing Jane to buy less pizza—the taxes cause deadweight losses and make the allocation of resources less efficient. As we have already seen, much government revenue comes from the individual income tax in many countries. In a case study in Chapter 8, we discussed how this tax discourages people from working as hard as they otherwise might. Another inefficiency caused by this tax is that it discourages people from saving. Consider a person 25 years’ old who is considering saving $1,000. If he puts this money in a savings account that earns 8 percent and leaves it there, he would have $21,720 when he retires at age 65. Yet if the government taxes one-fourth of his interest income each year, the effective interest rate is only 6 percent. After 40 years of earning 6 percent, the $1,000 grows to only $10,290, less than half of what it would have been without taxation. Thus, because interest income is taxed, saving is much less attractive. Some economists advocate eliminating the current tax system’s disincentive toward saving by changing the basis of taxation. Rather than taxing the amount of income that people earn, the government could tax the amount that people spend. Under this proposal, all income that is saved would not be taxed until the saving is later spent. This alternative system, called a consumption tax, would not distort people’s saving decisions. Various provisions of the current tax code already make the tax system a bit like a consumption tax. Taxpayers can put a limited amount of their saving into special accounts—such as Individual Retirement Accounts and 401(k) plans—that escape taxation until the money is withdrawn at retirement. For people who do most of their saving through these retirement accounts, their tax bill is, in effect, based on their consumption rather than their income. European countries tend to rely more on consumption taxes than does the United States. Most of them raise a significant amount of government revenue through a value-added tax, or a VAT. A VAT is like the retail sales tax that many U.S. states use, but rather than collecting all of the tax at the retail level when the consumer buys the final good, the government collects the tax in stages as the good is being produced (that is, as value is added by firms along the chain of production). Various U.S. policymakers have proposed that the tax code move further in direction of taxing consumption rather than income. In 2005, economist Alan Greenspan, then Chairman of the Federal Reserve, offered this advice to a presidential commission on tax reform: “As you know, many economists believe that a consumption tax would be best from the perspective of promoting economic growth—particularly if one were designing a tax system from scratch—because a consumption tax is likely to encourage saving and capital formation. However, getting from the current tax system to a consumption tax raises a challenging set of transition issues.” Q1: What should be taxed – Personal Income or Personal Consumption and why? Provide your opinion based on the case given below. (200 words)[2.5 Marks] Q2: How may it affect Saudi Economy if an income tax is imposed in KSA?(200 words)[2.5 Marks]
ECON 201 SEU When Taxes Induce People to Change Their Behavior Case Study

SCM 800 Penn State World Campus West Marine Case Study Discussion

custom writing service SCM 800 Penn State World Campus West Marine Case Study Discussion.

Question 1: Please draw a schematic diagram of the West Marine supply chain. This diagram would fit somewhere between a process flow diagram and a value stream map. (20 total points) Based upon the information in the case only, add all the information to the diagram that you would think a responsible supply chain manager would require using this diagram to help him/her analyze this supply chain. (For example, number of sku’s, inventory safety stock, etc.) This information should be placed on the schematic. Utilizing the notes section of the slide, list the three most important bits of information (not mentioned in Part A above) you think would be beneficial to assist a supply chain manager in evaluating this supply chain. So, what information is missing from the case that you would like to know so that you could analyze the case more fully? This situation happens all the time in industry! Briefly (and the key word is briefly but be very specific) explain why you would need this information from Part B of the question. From whom and how might you obtain the information in Part C? Be specific! Question 2: List and explain the primary dangers of executing an acquisition when the company does not have a solid supply chain foundation? Utilize the point in time just after the E&B acquisition. (30 total points) Sometimes when you are inside a company it is difficult to see the forest for the trees–always fighting today’s battles! Therefore, for this question place yourself in the position of a consultant with 100% complete access to West Marine via the case. The intent of this question is for you to probe the case for the strategic dangers that lurk in the absence of a solid supply chain infrastructure Do not use “lack of strategy” as an answer!! An average response will identify at least two dangers.A top-level response will identify three. Do not exceed three! I am not looking for extensive lists—I am looking for depth and breadth. Discuss each danger separately. Question 3: What supply chain improvements were necessary for WM to turnaround its supply chain performance? (20 total points) Discuss each improvement separately. The intent of this question is for you to probe the case for the most important underlying problems and there causes that WM must address. You must define the problem before you can solve the problem! Also, be sure to explain or make an argument justifying why your solution solves an existing problem.This question consists of two parts:Why and How! Discuss each item separately.Be specific and freely use examples from the case when responding to this question! The lack of examples from the case is a typical area where students lose points.For this set of questions, be certain that you focus on the Boat U.S. acquisition! An average response will identify at least two improvements. A top-level response will identify three. Do not exceed three! I am not looking for extensive lists—I am looking for depth and breadth. Question 4: Why is CPFR important? How did CPFR help WM address its supply chain challenges? (20 total points) Question 5: Is WM ready for the Boat U.S. acquisition? YES, or No…you cannot pick both. Take a stand! What are its primary supply chain problems — as they relate to CPFR? What are the risks associated with each one of those problems? Explain your reasoning and how it might tie back into previous modules. (30 total points) An average response will identify at least two items. A top-level response will identify three. Do not exceed three! I am not looking for extensive lists—I am looking for depth and breadth. Discuss each risk separately. VI. Grading Criteria: West Marine PowerPoint Presentation Assignment: (The instructor reserves the right to change the grading criteria for this assignment without notice.) PowerPoint presentations are another communication device that stresses organizing thoughts in the appropriate hierarchy and sequence, selecting words for their power and expressiveness, using technical terms in appropriate contexts, representing complex data and symbols precisely in prose. They require the use of appropriate business language; do not use slang language, or colloquialisms, etc. Analysis: (About 120 points) 1. Does the PowerPoint presentation answer each of the questions? 2. Does each answer to a question contain analysis of the major issues? 3. Does the analysis for each question incorporate concepts/techniques from all readings (including previous modules)? 4. Does the analysis effectively incorporate information from the case? 5. Does the analysis show relationships among important factors? 6. Are assumptions explicitly stated? 7. Does the analysis isolate fundamental causes of the problems? 8. Does the analysis contain enough detail to support recommendations, causes and effects, etc.? 9. When the analysis is undertaken does it use the information at its disposal correctly, thereby leading to correct answers. 10. Does the presentation utilize the information and apply it to today’s environment? 11. Are the risks associated with this case discussed in detail? 12. Do the notes section of the slides contain enough detail to explain the slides? Quality of Professional PowerPoint Slides: (About 60 points) 1. Are the slides logically organized? 2. Is the presentation readable and does it flow with continuity? 3. Are rules of grammar, punctuation, spelling, sentence and/or paragraph construction, uppercase/lower case, etc. followed? 4. Is the PowerPoint presentation concise & succinct? Is the presentation length 13 slides? 5. Do the slides support, amplify and clarify your answers? 6. Do the slides represent correct information? 7. Is the presentation visually attractive? 8. Was the “Notes” section in PowerPoint utilized to add depth to the presentation? 9. Do the slides use a common font, theme, layout, size, upper/ lower case letters, etc.? 10. Does the PowerPoint deck contain an agenda slide, overview, or objectives slide? 11. Does the deck contain a schematic of the supply chain that is under analysis? 12. Does the deck contain a summary slide that lists the “next steps” that should be taken to move the process forward? 13. Do the PowerPoint slides have graphics, a short video, etc. that help to emphasize your points? You must explain in the “Notes” sections how this clip adds to your answer! 14. Were citations used on the appropriate slide or note section? Overall Criteria: (About 20 points) 1. Is the PowerPoint presentation logically consistent and effectively structured–so it sells its ideas? 2. Is there a high likelihood that the recommendations will achieve their intended results?SCM 800West Marine Case Team AssignmentACADEMIC INTEGRITY:This deliverable IS a group assignment. You are on your honor. You cannot discuss any aspect of this case or anything related to it with any other teams. You cannot use any outside resources other than your notes, course articles and material, and your own team members. One of the biggest problems I have encountered with this assignment is plagiarism. Please cite any sources you may use.Assignment Document: This document includes the following assignment information needed to complete this case assignment: Assignment Objectives Assignment IntroductionAssignment Directions Assignment Guidelines and Requirements Assignment QuestionsGrading Criteria Cover Page and Academic Integrity PledgeI. Assignment Objectives:The goal of this assignment is to utilize concepts mastered and apply them in a real-world setting. West Marine explores various themes including but not limited to the following:Evaluate CPFR and its impact of a firmExplore issues surrounding collaboration and coordination in a supply chain environmentAnalyze the impact of mergers and acquisitions on supply chain managementIllustrate implementation challenges and propose solutions utilizing CPFRSpecify and analyze various costing issuesAssess risk and mitigation strategiesII. Assignment Introduction: This real-world case assignment is designed to help students evaluate the use of a collaborative approach to integrating across the SCOR processes of Plan, Source and Deliver (Customer Fulfillment) within the context of a retail environment. Teams will assess the firm’s supply chain before and after the implementation of CPFR. They will analyze the existing supply chain’s problems, propose solutions, and will critically evaluate the CPFR process—including its strengths, weaknesses, implementation challenges, and operational issues.III. Assignment Directions: Your team’s responses to the West Marine assignment questions are to be organized into a professional PowerPoint presentation of approximately 12 slides. Prepare the presentation in the “Normal” view, utilizing a portrait format to make liberal use of the “Notes” feature on all slides. PowerPoint slides, by necessity, must be brief. Therefore, use the notes feature to justify or more fully explain the bullet point content of a slide. Do not leave the instructor guessing on the meaning of a particular slide. You might think of the notes as containing material you would state if you were verbally presenting your slides. Please, do not write volumes in the notes section. Be concise but clear on the meaning of each slide. All your extra information about a particular slide must fit on that 8.5 by 11 portrait version of the “Notes” page for a particular slide. Also do not re-write the question on the notes slide. Please just write either Q1, Q2, Q3, etc. at the top of the notes section.The presentation should begin with a brief introduction giving some background on the case and stating the purpose (Objectives/Goals Type Slide) and organization of the presentation (Agenda Type Slide). The introduction should then be followed by your response to each of the assignment questions. There are multiple sets of questions associated with this case and most of the questions contain multiple parts or sub-questions. Please be certain to address each part of each question set. Also, please be sure that you make it clear to the reader that you have addressed each part of each question. This information should be very clear in the “Notes” section and will have to appear on the slide portion of the presentation.When you are asked to make a choice or take a position in answering a question, be certain to present the argument or justification for your choice. In support of your position, it is often useful to draw on the literature that you have read for the course.Note: Arguments can be used to positively affirm a particular position as well as to indicate that alternatives are not worthy of support. In other words, sometimes you can support a position by effectively arguing against other alternatives.The two biggest problems I find with these types of presentations and team assignments are as follows: All team members do not review all answers prior to submission–leading to incorrect, incomplete, and less than satisfactory responses. This problem is huge. I strongly suggest all members of the team re-read all of the information in the syllabus and in other areas of this course discussing how all team members must participate is all aspects of the case. Teams do not use enough examples as they justify a position. Please note: The team should place citations on the slides as needed that illustrate the problems/questions/goals/objectives, etc. you are trying to obtain. See the Course Schedule for due dates for these deliverables.IV. Assignment Guidelines and Requirements: 1. Your team’s responses should be organized into a professional PowerPoint presentation of approximately 12-13 slides. Is the presentation concise & succinct? 2. All extra information about a slide must fit on that 8.5 by 11 portrait version of the “Notes” page for a slide. 3. Do not use any pdf type files in your submittals—PPT only. PPT should be formatted to print the slide and notes section. 4. The presentation must be formatted for single sided printing (no double-sided reports). Please preview print before submitting-make sure it is formatted correctly. 5. Please read the attached grading rubric for additional information that will be considered when the assignment is graded. 6. Use bullets on the slides…no long sentences or paragraphs. 7. Does the PowerPoint deck contain an agenda slide and objectives slide? Not counted as part of the total.8. Does the PowerPoint deck have a summary slide? Not counted as part of the total. 9. Please use proper citations when necessary on the appropriate slides. Do not plagiarize. 10. Please include & use the enclosed cover page or similar page transcribed to PPT. 11. Points will be deducted for not following formatting directions and not answering all assignment questions. 12. Utilize graphics or even a short video to help emphasize a concept or elaborate on an answer to a question. 13. Any appendices type slides must be numbered and have a title. You cannot have more than one appendix per slide. You can only use one side of the paper. 14. All work must be completed in a professional manner. 15. Please note: We do not have pre-grading of any of the assignments. 16. We do not allow resubmittal of the assignment after it is graded. 17. You will have only one document downloaded to the drop box: 1. The actual document in PPT type file extension. This deck will include use of the ‘notes’ portion 2. No other documents are required…no Excel files, Word documents, etc.
SCM 800 Penn State World Campus West Marine Case Study Discussion

ENGH 202 THS Portrayal of Torture in Zero Dark Thirty Question

ENGH 202 THS Portrayal of Torture in Zero Dark Thirty Question.

Write a conversational but coherent response to the following question:What do you think of the portrayal of torture in Zero Dark Thirty? Instead of thinking about whether the film is a kind of apology for torture (I think it is), I would rather you think about perspective, point of view, and torture. Whose POV does the film privilege in the torture scenes? How does the film portray US torturers vs non-US torturers? What assumptions does the film encourage its audience to make about 1) the people who are tortured and 2) the reasons that they are tortured? I think these questions will help get at what is so deeply disturbing about this movie and Bigelow’s work in general. I will write the links below of the prezi and film in order to help you answer the question above. https://prezi.com/view/qQ9lO7yfcMOoFHFXWayT/https://prezi.com/view/AJ6cm2XyNsaLByp4fKXY/
ENGH 202 THS Portrayal of Torture in Zero Dark Thirty Question

A Look At Leadership Psychology Essay

A Look At Leadership Psychology Essay. In a changing corporate world, strong leadership is becoming necessity for their survival Bennis nanus,1985.Complexity and chaos are creating emerging concerns in solving problem in business world, which leads more attention to leadership. This in turn has increased arguments how leadership is different from management. Management focus on responsibities and reaching goals effectively and efficiently which means it is the activities that keeps organization running(Huey,1994).However leadership is a role to influence others and guiding them to go in right direction to effectiveness(BennisA Look At Leadership Psychology Essay

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