Other Assignment Example | Topics and Well Written Essays - 1000 words

Other - Assignment Example While buying the television, the seller will have spent on something else thereby boosting the local economy. Therefore, in the perspective of the observer of these events, the ill behavior of the man’s son or breaking of the television set has stimulated the economy; however, according to Bastiat, the entire understanding exposes a fallacy. Looking at the concept brewed in this case, breaking of the television reduces the man’s disposable income that he may not be able to purchase; for instance, a new shirt or commit to other luxuries. Nonetheless, the breakage of the television is helpful to others; for example, the seller or the person repairing the television. It should be noted that despite the breakage of the television set being helpful to others; it robs industries and reduces the spending on other goods and or services. Replacing an item that was already bought is regarded as the maintenance cost as opposed to buying new items or items that the owner has never had (Rockwell and Ludwig Von Mises Institute, 2008). ... in Making Financial Decisions The most significant means in decision making including financial decision-making are the application logical and systematic decision-making processes. Application of application logical and systematic processes helps in time value analysis since they provide systematic and planned analysis. Therefore, it is vital that health care organizations to deploy organizational approach that incorporates application logical and systematic processes in making vital financial decision (Skousen, 2009). Applying this concept will ensure that they never miss profound factors in their decision-making. Six steps and practices can help the health care organizations to curb their challenges in financial decision-making. Creating a constructive environment for financial decision making A constructive environment for decision-making incorporates the establishment of objective of such decision making process. In other words, it is vital that the management of such health car e organization to define the parameters the health organization could achieve with their desired financial decision. Additionally, the management must thereafter agree on a working process to be deployed and this will call for the incorporation of the significant stakeholders in such decision-makings. Generating applicable and relevant alternatives This process shall provide the decision makers with more options to choose from towards comprehensive financial decisions. Generation of alternatives allows the management or the decision makers to have numerous ways of solving financial challenges. Therefore, unreasonable alternatives will only worsen the problem. Finally, generating alternatives will help organizations of ideas. Exploration of the alternatives This process ensures that only

Mentorships nursing Essay Example | Topics and Well Written Essays - 1500 words

Mentorships nursing - Essay Example In order to perform the mentorship role effectively and fulfill their obligations, mentors should acquire some traits that are essential to define their role. These attributes consist of: friendliness, good sense of humor, patience, solid interpersonal skills, approachability and professional development abilities (Morton-Cooper& Palmer 2005). Although these characteristics are incorporated in individual’s personality, staff teaching and mental preparation plays a vital role in establishing relationships between tutor and student. In order to critically evaluate these qualities, mentor can facilitate the needs of a student. It is clear that the natures of these attributes are a testament towards cultivating a solid learning environment. Although this relationship is evident; it does beg the question, how does the relationship between mentor and the tutor begin to cultivate? What factors accumulate to solidify this relationship? The second question that poses from this study is—what are the roles and responsibilities of a mentor? In addition, how does one prepare themselves to face these challenges? Lastly, what knowledge is needed to become involved in student supervision? In essence, quality is vital because it promotes education and professional development. Conducive research suggests that the quality and nature of the mentoring relationship is fundamental towards creating a self-reliant and confident relationship. It enhances the quality of the learning sessions experience (Cahill 1996, Andrews and Wallis In the initiation phase, the mentor and the student familiarize themselves with each. They work together through collaboration and observe each other closely. Here, the initiation of harnessing support and having access each other, and is crucial to their development of the relationship. At this phase, commitments can

The New Testament Essay Example for Free

The New Testament Essay The New Testament is deeply rooted in what Friedrich Nietzsche called slave morality. Its sense of ethics and the social values it expounds can be described as a downward pull towards a constant affirmation of a shameful human. One can see the New Testament as copying the ideals of the Old Testament, for the entire Judeo-Christian message is simply, echoing Mikhail Bakunin: God is everything, humanity is nothing; God is the master, humanity its slaves. As such, ethics, values and virtues that sprang from the New Testament is and will always be that of a slave race. Knowing that Jesus himself was highly influenced by Judaic tradition, one can say that the New Testament is merely a continuation of the Old Testament. The ethical atmosphere of the classical civilizations of Greece and Rome were different from that of the Judeo-Christian one. The Greeks and the Romans were far more positive in their outlook of life and their civilizations were a mish-mash of what Nietzsche referred to as Apollonian and Dionysian elements. Whereas the Judeo-Christian God rules and controls all, the Greeks and Romans were able to construct a system where Fate controls all including the gods and goddesses themselves. Unlike the Hebrew and Christian â€Å"slave†, the Greek â€Å"human† is not a product of his God but of his passion, his capacity to reason, and his past. There may be gods and goddesses, but they exist as part of a hierarchy in nature. When a man fears a god, it was because of that god’s power (and there were many a variants of such powers). A man therefore fears god because he saw god as a superior; but this does not mean that he saw god as a master. On the contrary, a Greek or a Roman may imagine himself powerful enough to challenge the gods. The gods were feared because of their powers and not in the Christian sense when people fear God in fear of a brutal punishment in the afterlife. Thus, the Greco-Roman ethical atmosphere promotes what Nietzsche called master morality. What was valued more was the capacity of human beings to rise up towards the level of a god (like Homer’s Achilles) and not how much one has knelt before a God. There may be a noble acceptance that the actions of the gods were considered fate (as in Virgil’s Aenied), human actions still determine whether this or that human becomes a master or a god. What is similar between the Greco-Roman and Judeo-Christian the sense of ethics and sets of values and virtues is their obsession for what is ideal. Greco-Roman values are based on the philosophy of a form and substance, where the form may suffer changes but its substance remain permanent. Changes may extinguish the form but the substance never perishes. Plato’s cave demonstrates this duality in reality. In the Judeo-Christian sense too resides this duality: body and soul. The body may perish but the soul does not. Taking care of the soul is therefore first priority of Judeo-Christian morality while deciphering and understanding the substance is the first priority of Greco-Roman philosophy. This difference is highlighted by the fact that Jesus’s taught his wisdom through verbal parables concentrating on morality, Homer and Virgil through their written vulgar display of the human senses in its struggle against godly intuitions, while Plato in his philosophical tracts that promoted a certain degree of idealism. This difference between Jesus and the classical writers can also be attributed to their audiences: slave morality for Jesus, master morality for the classical writers. Thus, Jesus himself was continuing a tradition deep into the world of the Old Testament â€Å"slaves† and in fashioning himself as the Jewish messiah his teachings were meant to salvage his world the same way as Moses salvaged his. The decadence of Jewish society during the time of Jesus was reminiscent of the Hebrew society before Moses came down with the two tablets in his hands. Jewish society had become a corruption of its former radiance and the teachings of the Christ was supposed to clean away such corruptions. Whereas Homer, Plato and Virgil wrote in attempt to expose the human spirit in its pure and real substance, Jesus spoke of that spirit’s final destination. The New Testament, in this sense, failed to realize that most of the time the journey of the human spirit is more important than its destination.

Case Summary Hypertension In Pregnancy Health And Social Care Essay

Case Summary Hypertension In Pregnancy Health And Social Care Essay Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is at 37 weeks and 5 days of gestation. She was diagnosed to have hypertension in pregnancy during antenatal routine follow-up in Klinik Kesihatan Simpang Renggam at 36 weeks and preeclampsia (blood pressure 160/100mmHg, urine dipstick albumin 1+) 3 days before admission. She was admitted to Hospital Kluang and started on Tab. Methyldopa 250mg TDS. She was advised for induction of labour in view of preeclampsia at term and she requested to be transferred to Hospital Batu Pahat (HBP). She did not have any signs and symptoms suggestive of severe preeclampsia or labour. During admission to HBP, tablet prostin 1.5mg was inserted into the posterior fornix twice to induce labour but there was no change in cervical os and symptoms of labour. Decision was made to try artifical rupture of membranes. However, following the procedure, internal monitoring detected fetal distress and as spontaneous delivery was not imminent, Mdm. S M was agreeable for emergency lower section caesarean section under general anaesthesia. A healthy infant boy was delivered (weight 2.9kg, Apgar score 91105) and there were no intra or post-operative complications. Following the surgery, both mother and infant were well in the ward. Mdm. SM was ambulating and tolerating orally and by the 2nd post-op day, both had passed urine and motion. Wound inspection on day 2 showed clean, non-gaping wound. As she was well, decision was made to discharge her and she was given appointment to review her blood pressure and operative wound at the postnatal clinic at KKSR. On discharge, her blood pressure was 140/70mmHg (without medication) and urine dipstick albumin was trace. Analgesia given on discharge were mefenemic acid and paracetamol. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology PATIENTS DETAILS I/C NUMBER: 800318015794 AGE: 30 SEX: Female DATE OF ADMISSION: 20/6/2010 R/N: 1358593 2) CLINICAL HISTORY Chief Complaint Elevated blood pressure detected in pregnancy at 36 weeks of gestation. History of Present Illness Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is currently at 37 weeks and 5 days of gestation. She was referred to Hospital Kluang from Klinik Kesihatan Simpang Renggam (KKSR) for elevated blood pressure detected on routine antenatal follow-up and subsequently transferred to Hospital Batu Pahat (HBP) for induction of labour in view of her development of high blood pressure in pregnancy. Her elevated blood pressure was first detected during her routine antenatal follow-up at Klinik Kesihatan Simpang Renggam 10 days before admission to HBP. During this visit, her blood pressure was recorded as 150/90mmHg and she also complained of slight bilateral swelling of her feet but otherwise had no other complaints. The feet swelling resolved after 3 days. Throughout the next 7 days, she went to KKSR every alternate day for monitoring and 3 days before admission to HBP, her blood pressure was noted to be 160/100mmHg with presence of albumin 1+ on urine dipstick that was prev iously not present. She was immediately given tablet labetolol 100mg and admitted to Hospital Kluang where she was subsequently started on tablet methyldopa 250mg 8-hourly. Three days after admission to Hospital Kluang, she was advised by the doctor to undergo induction of labour and she thus requested to be transferred to HBP so her family members in Batu Pahat could take care of her. During the course of these events, she did not experience shortness of breath, headache, blurring of vision, epigastric pain, seizures, abdominal pain, vaginal bleeding, nausea, vomiting, palpitations, or recurrence of the foot swelling. At time of admission, she did not experience contraction pain, show, leaking of liquor. Fetal movements were good. Systemic Review Mdm. SM did not have fever. Her appetite was good and her urinary and bowel habits were normal. Her sleep was unaffected. Antenatal History This was an unplanned but wanted pregnancy. Mdm. SM realized she was pregnant when she missed her period, of which the last was 28/12/09. She bought a pregnancy test kit and it tested positive. She subsequently did her booking at KKSR at 7 weeks of period of amenorrhoea. At booking, her blood pressure was 120/80mmHg, hemoglobin 13.4g/dL, sugar undetected, and urine albumin negative. Infective screening was negative and blood type O positive. Her expected due date was given as 14/8/10. During follow-up 1 month later, she had her first ultrasound scan which found her uterus to be larger than dates. Her due date was revised to 6/7/10. Modified glucose tolerance test done twice during pregnancy were negative. She experienced morning sickness and vomiting during the first 3 months of pregnancy but it was not severe and she could cope without medication. Throughout the pregnancy, she was diagnosed to have urinary tract infection twice and was treated with antibiotics. A further 3 ultrasoun d scans were done and all were normal. She was also compliant to the supplements given throughout pregnancy. There were no other problems during the antenatal follow-up until the detection of elevated blood pressure 10 days before admission to HBP. Past Obstetric History This is her fifth pregnancy and her last childbirth was in 2008. She has 3 children, 2 boys and a girl, of whom all were born via vaginal delivery at postdate after induction of labour. Birth weights ranged from 2.7 to 3.0kg, all are healthy with no complications and were breastfed. However, during her 3rd pregnancy, she suffered a miscarriage during the 12th week and dilatation and curettage was performed during that admission. Gynae Menstrual History Mdm. SM achieved menarche at the age of 12. Her menstrual cycles have always been regular with 28 days per cycle and 5 to 7 days of flow. She does not experience menorrhagia or dysmenorrhoea. She has never had a cervical smear done and has never used oral contraceptive pills. She has not required medical attention for any gynaecological problem. Past Medical History Mdm. SM has never been diagnosed with any chronic disease such as diabetes, hypertension, and asthma before. She has also never been admitted for non-pregnancy related reasons. She also does not have any known food or drug allergies. Family History Mdm. SM is the eldest of three siblings. Her youngest sister also had gestational hypertension. Her father has hypertension and her mother had diabetes, but passed away 2 years ago due to tuberculosis. All family members have been screened and all tested negative for tuberculosis. Social History Mdm. SM is now a housewife. She formerly worked in a factory but decided against returning to work following her last pregnancy in 2008 for her childrens benefit. She is a non-smoker and does not consume alcohol. Her husband is a short-haul lorry driver and smokes, but only outside their home. They live slightly off Kluang, and it takes them slightly over an hour to reach HBP, and 15 minutes to reach KKSR. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 3) FINDINGS ON CLINICAL EXAMINATION (Mdm. SM was examined by me on the 2nd day of admission) Mdm. SM was alert, conscious and cooperative. She was not in any pain or distress. She was sitting comfortably on her bed. On examination, there was no pallor, jaundice or pedal edema. Her reflexes were not brisk. Her clinical parameters are: Blood Pressure : 124/80 mmHg Heart Rate : 95 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37 °C Examination of the cardiovascular system, respiratory system, fundus, thyroid and breasts were normal. On examination of the abdomen, it was distended with gravid uterus as evidenced by linea nigra, and striae albicans. There was no striae gravidarum, scars, or pulsations noted. On palpations, the abdomen was soft and non-tender, uterus non-irritable, and fetal parts felt. The symphysio-fundal height was 36cm, which corresponds to dates. On examination, this is a singleton fetus at longitudinal lie with cephalic presentation, with the fetal back on the maternal left. The fetal head was four fifths palpable. Estimated fetal weight is 2.8 to 3.0kg. Liquor is adequate. Fetal heart was heard and the rate was 142 beats per minute. Vaginal examination (by medical officer on admission) revealed no perineal, vulval or vaginal abnormalities. Cervical os was 1 cm with cervix tubular, soft and axial, station high and membrane intact. Bishops score was 3/10. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Preeclampsia in pregnancy Mdm. SM developed new onset elevated blood pressure of 160/100mmHg at 36 weeks of gestation and urine dipstick albumin of 1+ (300mg/L). This fits the minimum requirement of preeclampsia among the hypertensive diseases in pregnancy. However, Mdm. SM did not experience any symptoms to suggest a severe preeclampsia or impending eclampsia such as headache, visual disturbances, epigastric pain, vomiting, liver tenderness. The urine dipstick for albumin is not the best way to detect proteinuria required for the diagnosis of preeclampsia 3 and is usually only used for screening, but as the blood pressure and urine albumin were persistently elevated, it is better to err on the side of caution and treat Mdm. SM as such since patients with relatively mild preeclampsia can rapidly progress into severe disease 1. Following the repeated positive detection of urine albumin of only 1+, more definitive tests should be performed to better quantify her proteinuria 2,3. Differential Diagnosis Pregnancy-induced hypertension, late onset As Mdm. SM has been compliant to her antenatal follow-ups and did not have elevated blood pressure detected at any time before 36 weeks of gestation, it is likely that she has developed the onset of a hypertensive disease in pregnancy and it appears to be of late onset as it developed only after 32 weeks gestation. However, as subsequent visits showed urine dipstick albumin of 1+, indicating the onset of proteinuria (although poor predictive value and not as significant as 2+) 3, it might prove wiser to be more vigilant and assume that Mdm. SM does indeed have preeclampsia as it would be foolish to dismiss these warning features despite the fact that she does not demonstrate any suggestive symptoms because it is possible that even patients with no prodromal signs may suddenly progress into eclampsia 1,3. Essential hypertension in pregnancy with superimposed preeclampsia Another possibility that we may entertain is that Mdm. SM has had previously undiagnosed essential hypertension with currently superimposed preeclampsia. However, this seems rather unlikely. Firstly, Mdm. SM is young at the age of 30 and unlikely to suffer from essential hypertension as this disease common presents after the age of 40. Secondly, at no time throughout antenatal follow-up did she have elevated blood pressure recorded before that particular visit at 36 weeks of gestation. However, following delivery of her infant, she should have her blood pressure rechecked during postnatal follow-up care at 6 to 12 weeks post-delivery. If her blood pressure if still elevated at that time, then it will be more likely that she has essential hypertension. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Elevated blood pressure and its implications in pregnancy Mdm. SM has newly discovered elevated blood pressure at 36 weeks of gestation. This is considered late onset but is not uncommon, and gives rise to a spectrum of hypertensive disorders in pregnancy. While it seems that at first she has gestational hypertension, the mildest of the disease spectrum, she demonstrated proteinuria on her subsequent antenatal visit, therefore concluding that she has preeclampsia. Hypertensive disorders in pregnancy have the potential to put both mother and infant at increased risk of mortality. Its complications are elaborated below. During admission, Mdm. SM should be monitored for any change in her condition as she may quickly progress into severe disease states and this would require urgent intervention, the most definitive being the delivery of the infant. Ward management includes close observation of both mother and infant, and medication to control the elevated blood pressure. 2. Induction of labour in view of preeclampsia at term Termination of the pregnancy is the only definitive sure for preeclampsia. On presentation, Mdm. SM has features categorized as mild preeclampsia. Normally, severe preeclampsia would dictate the need for antihypertensive and anticonvulsive therapy followed by subsequent delivery and symptoms such as headache, epigastric pain, and visual disturbances may indicate this. The fetal age is usually an important deciding factor when it comes to inducing labour as the treatment goals seek the best outcome for both mother and infant. As Mdm. SM is already at term and there have been no issues previously detected regarding the health of her fetus, it should be safe to proceed with induction of labour. There is also no reason to prolong the pregnancy as the risk of eclampsia increases. If for any reason an obstetric reason arises e.g. fetal distress, delivery should proceed via caesaren section. 3. Impending eclampsia and other potential complications Warning signs and symptoms of impending eclampsia or severe preeclampsia include headache, visual disturbances, epigastric pain, reduced urine output, edema and ultimately, convulsions. These symptoms should be recognized early so the necessary intervention can take place. Seizures increase the risk of maternal and perinatal morbidity and mortality rates. Some maternal complications are placenta abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, and acute renal failure. Other major complications that may occur as a result of severe preeclampsia are HELLP syndrome, pulmonary embolism and stroke. Fetal complications include growth restriction, fetal distress, and death. 4. Risk of post-partum eclampsia It is possible for eclampsia to occur in the postpartum period especially when the patient has reached term. In such cases, up to 44% of eclampsia occurs postpartum 3. As the risk is quite high, Mdm. SM should continue to be monitored in the ward for the development of any signs and symptoms. As she is comfortable and relatively symptom free while in the ward, it appears unlikely that she may worsen into an eclamptic state but the risk should not be afforded. As there are no guidelines to suggest an optimum postpartum inward observation period, it would depend on her clinical situation during the subsequent days following her delivery. 5. Hypertension in pregnancy and its long term implications As Mdm. SM has developed preeclampsia during this pregnancy, she is at increased risk to develop hypertensive or metabolic complications in future pregnancies. The risk of recurrence is generally higher in earlier onset preeclampsia. At the same time, she should be evaluated in the postpartum period for the possibility of essential hypertension at the 6 week postnatal review. Also, women with preeclampsia are at an increased risk for developing hypertension, diabetes, hyperlipidemia, chronic renal disease, stroke and ischemic heart disease. Mdm. SM should be made aware of all these implications and should be educated on how she can prevent these via the modification of her lifestyle. She should also be advised to attend preconceptual counseling in the event of a future pregnancy and to come early for booking. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Urine Dipstick for Albumin To look for the presence of albumin in the urine firstly, to confirm proteinuria, and secondly, to evaluate the severity of the preeclampsia. Urine dipstick for albumin should be repeated daily in the ward. Also, if in doubt, further investigation to quantify proteinuria can be done e.g. urine protein/creatinine spot test 2,3. Results: Urine dipstick albumin on admission was trace. Results at KKSR showed 1+. Interpretation: This result could be due to the fact that the blood pressure has lowered as Mdm. SM has been started on methyldopa and her blood pressure is under control. This does not mean that she no longer has preeclampsia. She should be checked daily for any changes in both blood pressure and proteinuria. 2. Full Blood Count To look for anemia which may require correction, haemoconcentration which may indicate severe preeclampsia 1, and platelet levels as HELLP syndrome is a complication that may arise in preeclampsia. This may also serve as baseline in case operative procedures are required. Result: TWBC 12.0 x109/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ (neutrophils 8.20, lymphocytes 2.70) Hemoglobin 10.7 g/dL à ¢Ã¢â‚¬  Ã¢â‚¬Å" Hematocrit 32.3% à ¢Ã¢â‚¬  Ã¢â‚¬Å" Platelets 354 x 109/L Interpretation: The total white cell count is slightly raised, but this is to be expected in pregnancy. The hemoglobin is slightly low but this is also expected in pregnancy and should be monitored especially if the patient requires surgery or experiences anemic symptoms. There is no haemoconcentration and the platelets are normal. 3. Prothrombin Time, INR, Activated Partial Thromboplastin Time (PT/INR/APTT) To obtain a baseline of the coagulation profile in case operative procedures are required and also to look for potential coagulopathy as it is a possible complication of preeclampsia. Result: PT 12.3s INR 1.05 APTT 39.6s Interpretation: PT/INR/APTT is within normal range. Coagulopathy appears unlikely in Mdm. SM given that her platelets are also normal and her preeclampsia is not severe. 4. Renal Profile To assess renal functions to look for elevation of creatinine as that would indicate severe preeclampsia and also to detect acute renal failure which is associated with increased risk of HELLP syndrome, placenta abruption and postpartum hemorrhage 1. Result: Urea 1.3mmol/L Sodium 140mmol/L Potassium 3.7mmol/L Creatinine 51 µmol/L Interpretation: Mdm. SM renal profile is normal and creatinine is not elevated, adding to the indicators that her preeclampsia is of the mild category. Low urea levels and good urine output also rules out acute renal failure. 5. Liver Functions Test To assess liver functions and its components such as liver enzymes and bilirubin which would be raised in severe preeclampsia or HELLP syndrome in which there is hemolytic anemia and elevated liver enzymes. Result: Total protein 73g/L Albumin 33g/L Globulin 40g/L Total bilirubin 0.5mg/ml Direct bilirubin 0.2mg/ml Indirect bilirubin 0.3mg/ml ALP 121U/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ ALT 7 U/L GGT 7 U/L Interpretation: Liver enzymes (ALT) and bilirubin levels are not elevated, indicating a mild preeclampsia and no biochemical evidence of HELLP syndrome. The ALP is slightly elevated, but this could be due to compression of the gravid uterus on the hepatobiliary tree. 6. Serum Uric Acid Elevated serum uric acid is an early biochemical sign of preeclampsia 1 and may help to predict maternal complications in preeclampsia 4. Results: Serum uric acid 103 µmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" Interpretation: Serum uric acid levels are not elevated and are in fact, slightly lowered. This result indicates low likelihood of severe preeclampsia or maternal complications. 7. Serum Lactate Dehydrogenase To check for elevated levels which should indicate hemolytic anemia, a component of HELLP syndrome. Results: Not done during this admission. 8. Cardiotocograph (CTG) Done on admission as a baseline for fetal monitoring. Results: Baseline fetal heart rate was 130 beats per minute, baseline variability was 5 10, accelerations present with no decelerations. Interpretation: CTG is reactive with no signs of any fetal compromise. CTG should be repeated following each procedure e.g. prostin insertion, AROM or if fetal compromise is suspected. 9. Transabdominal Ultrasonography This should be done to confirm fetal age, as confirmation of fetal age is important when it comes to deciding whether or not to induce labour in preeclampsia. Also to check for fetal well-being and growth restriction, but these requires repeated scans and plotting of growth chart over a period of time. Result: No ultrasonography was done during this admission. The last scan was done in Hospital Kluang before patient was transferred to HBP. The last scan reports fetal age corresponding to dates, AFI of 9, and no abnormalities detected with no mention of other findings. Interpretaion: As fetal age is corresponding to dates and there is no suggestion of fetal compromise or restriction, it is safe to proceed with induction of labour. 10. Urinalysis (UFEME) To check the levels of proteinuria which may be more quantitative than urine dipstick. Results: Leukocytes, nitrite, protein, glucose, ketone, urobilinogen, and bilirubin were not detected. Interpretation: No proteinuria was detected. This could mean that the patient does not have preeclampsia but rather gestational hypertension, or it could be undetected as the blood pressure has also become well controlled with medication. However, no risks should be taken and Mdm. SM should be closely observed in the ward. Either way, induction of labour and delivery would still be ideal for her as she has already reached term. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working Diagnosis Induction of labour at term in view of mild preeclampsia in pregnancy Comment: As Mdm. SM has elevated blood pressure and urine dipstick albumin 1+ but has no physical or biochemical features suggestive of severe preeclampsia, the working diagnosis is mild preeclampsia. However, she should be monitored closely in the ward for any symptoms indicative of disease progression. As she has reach term, it would also be wise to induce labour in her, especially given her history of postdates as delivery would be the only definitive management in such cases. Plan of management on admission Continue T. Methyldopa 250mg 8-hourly Daily urine albumin dipstick Vital signs monitoring 4-hourly Baseline cardiotocograph on admission Fetal kick charting and Labour progress charting To notify immediately if spontaneous rupture of membranes To notify immediately if strong contractions commence Encourage orally For induction of labour with T. Prostin 1.5mg as Bishops score unfavourable To notify immediately if any symptoms occur STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Throughout the first two days of admission, Mdm. SM was comfortable in the ward with no development of any symptoms of severe preeclampsia, eclampsia, or labour. Her vital signs were stable with blood pressure ranging 122-138/70-84. On the morning of the 2nd day, tablet prostin 1.5mg was inserted into her posterior fornix under aseptic technique. Cardiotocograph was reactive and vaginal examination 6 hours post-insertion showed cervical os 3cm, cervix 2cm, soft and axial, and high station. Therefore, a 2nd tablet of prostin was inserted on the morning of the 3rd day. Once again, post-insertion cardiotocograph was reactive and vaginal examination 6 hours later showed no changes to before. Mdm. SM still did not experience any signs and symptoms of labour. She also did not have any symptoms indicating progression of her preeclampsia. On the morning of the 4th day, it was decided that Mdm. SM should undergo artifical rupture of membranes (AROM) rather than have a 3rd prostin tablet inser ted. Cardiotocograph monitoring had been difficult so decision was made to insert fetal scalp electrode at the same time for internal monitoring. Following the AROM, internal monitoring revealed a drop of fetal heart rate from 130 to 100 beats per minute with no accelerations. Cervical os was still 3cm with no symptoms of labour. Decision was made to proceed with emergency lower section caesarean section (ELSCS) under general anaesthesia and Mdm. SM gave her consent. Via ELSCS, a healthy baby boy was delivered weighing 2.9kg with Apgar score of 91105. There were no intra or post-operative complications. Post-operative medications given include IV ampicillin 500mg QID, subcutaneous heparin 5000 units BD, IV pitocin 40 units QID, IM pethidine 50mg PRN, Tab. paracetamol 1g QID and Tab. Mefenemic acid 500mg TDS. Throughout the next 2 days, Mdm. SM was comfortable in the ward and had mild operative site pain with no other symptoms and vital signs were stable. All medications except analg esia were stopped. She was ambulating well, tolerating orally and had passed urine and motion by the 5th day. As for the baby, breastfeeding had commenced and he had also passed urine and motion. The uterus was well contracted at 22 weeks size and dressing was not soaked. Inspection of the wound on the 6th day revealed a clean and non-gaping wound. She was counseled on contraception and indicated a preference for intrauterine contraceptive device. As she was well, she was discharged with appointment to return to postnatal clinic at KKSR to review her blood pressure and operative wound in 1 weeks time. On discharge, her blood pressure was 140/70mmHg and urine dipstick albumin was trace. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan Tab. Mefenemic acid 500mg TDS PRN Tab. Paracetamol 1g QID PRN Follow-up appointment at Klinik Kesihatan Simpang Renggam (KKSR) Postnatal clinic in 1 week to review blood pressure and operative wound. Follow-up appointment at KKSR in 6 weeks for review, cervical smear, and contraception. Counseling Advised to return immediately to the hospital if Mdm. SM has problems with the caesarean wound e.g. pain, discharge or if she develops any new or worrying symptoms. Advised on the need to be compliant to postnatal follow-up to review Mdm. SMs condition. Advised for cervical smear during postnatal follow-up as previously never done. Counseling regarding breastfeeding and contraception. Explain about the nature of pregnancy-related hypertensive disorders and its long term implications. Advised to attend antenatal clinic for preconceptual counseling if future pregnancy is desired, or to come for booking immediately once discovered to be pregnant. Advised to observe a healthy lifestyle in order to prevent development of conditions such as hypertension and diabetes. Mock Prescription Tab. Paracetamol 1g QID PRN x 1/52 Tab. Mefenemic acid 500mg TDS x 1/52 STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 10) REFERRAL LETTER (IF APPLICABLE) Medical Officer, Postnatal Clinic, Klinik Kesihatan Simpang Renggam, 86200, Simpang Renggam. 20th June 2010 Mdm. SM (IC.800318015794) Date of admission: 20th June 2010, Date of discharge: 25th June 2010 Problem: Late onset hypertensive disease in pregnancy Dear medical officer, Mdm. SM is a 30-year-old Malay lady of parity 4+1 who was diagnosed to have preeclampsia at 36 weeks of gestation during routine antenatal follow-up at your centre. During admission to our ward, she underwent induction of labour with tablet prostin and artificial rupture of membranes. However, fetal distress developed, picked up on internal monitoring and Mdm. SM underwent emergency lower section caesarean section under general anaesthesia. She delivered a healthy baby boy (2.9kg, Apgar 91105) with no complications intra- and post-operatively. We are discharging her into your care. Please review her blood pressure as scheduled and also offer contraception and cervical smear as previously never done. She has indicated preference for intrauterine contraceptive device. Do not hesitate to contact us immediately should the need arise. Thank you very much for your attention. Yours sincerely, Paul Kong Fu-Xiang (Final year medical student, IMU), Department of Obstetrics Gynaecology, Hospital Batu Pahat. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1. Disease prevention and health promotion Hypertensive disorders in pregnancy are one of the most common antenatal problems and eclampsia is a major source of maternal mortality. What are the ways in which some element of prevention can be instituted or to decrease the severity of preeclampsia? There haven been certain strategies touted to prevent or modify the severity of preeclampsia. These are categorized as dietary supplements, antihypertensive medications, antioxidants, and antithrombotic agents 5. As low salt diet is one of the recommended dietary changes for hypertensive patients, De Snoo et al 1 was one of the earliest researchers to study the effects of low salt diet in preventing preeclampsia but this practice was discarded as it yielded no significant change. Knuist et al performed a randomized controlled trial in 1998 and they reported that despite helping control blood pressure in non-pregnant individuals, a sodium-restricted diet was ineffective in 361 women in terms of prevention of preeclampsia 6. The dietary supplementation of calcium of at least 1 gram per day is recommended as class I-A evidence 2. Several studies showed that women with low calcium diets were at significantly increased risk of gestational hypertension 7,8,9. Levine et al performed a large , randomized-controlled trial and they found that there was no significant difference in outcome with calcium supplements versus placebos 10. This suggests that unless a pregnant woman has a low calcium intake, calcium supplements may have no added benefit 5. With regards to fish oil supplements and its cardioprotective fatty a

Economies of Scale Essay -- Economics Economy Essays

Economies of Scale Economics Test 1. Define and explain all Internal Economies of Scale:  · Internal Economies of Scale:Are reductions in long-run average cost as the size and output of a firm increases. In other words, they are advantages that large firms have because they are large. As they grow larger in the long-run they manage to raise their output faster than the rise in their total costs. The result is lower long-run average cost. - Marketing economies- Both in buying materials and selling its finished goods a large firm is n a better position than a smaller one. In buying the products it needs, the large firm often pays less for raw materials, machinery and so on because suppliers are sure they are going to get large orders and do not want to lose a big customer. E.g. A producer of shoelaces will sell its products for à ¢Ã¢â‚¬Å¡Ã‚ ¤1 per packet to Nike because it has an order of 1000 packets per week. But for Adidas it will sell them à ¢Ã¢â‚¬Å¡Ã‚ ¤2 because it has only an order of 100 packets per week. So Nike has a lower cost per packet compare to Adidas. In selling its products, Nike can afford to pay for expensive and professionally made advertisements or employ specialist salesmen much easier than Adidas. The large total cost of advertising can be spread over a large output that is sold. Therefore, the average cost of advertising will be low. - Financial economies- If Nike is going to borrow money because it is a well known firm, it is considered more reliable, and less risky is easier to borrow than Adidas. So Nike can borrow a large amount of money with a lower interest rate compared to Adidas. E.g. If Nike borrows à ¢Ã¢â‚¬Å¡Ã‚ ¤1, 000000 it will pay an 8% interest rate while if Adidas borrows à ¢Ã¢â‚¬Å¡Ã‚ ¤1,000 it wil... ...At OQ the firm is enjoying Internal Economies of Scale and its average cost falls. Beyond this point, further growth would make the firm less efficient. Instead of producing with a low average cost, extra production would cause the average cost of each unit of output to rise. 8. Why do small firms still exist? - New firms - Firms do not start large. In other words. Many firms are small because they are new. Those that will be successful are expected to become large over the years. - Desire to remain in control- Sometimes owners of small firms may not want the firm to grow too large in case they lose personal control. - Lack of Finance- Small firms find it difficult to expand because they cannot raise finance. Large companies have huge retained profits and also can sell shares to the general public. Small firms can neither of these.

Welch On Management :: essays research papers

MGT4121 Week Eight Journal Submission : Chapter 14 Case Study: Jack Welch In a classroom where Jack Welch has appeared more than 250 times in the past seventeen years to engage some 15,000 GE managers and executives, something extraordinary happens. The legendary chairman of GE, the take-no-prisoners tough guy who gets results at any cost, becomes human. His slight stutter, a handicap that has bedeviled him since childhood, makes him oddly vulnerable. The students see all of Jack here: the management theorist, strategic thinker, business teacher, and corporate icon who made it to the top despite his working-class background. The fact is no one leaves the room untouched. If leadership is an art, then surely Mr. Welch has proved himself a master painter. Few have personified corporate leadership more dramatically. Fewer still have so consistently delivered on the results of that leadership. For 17 years, while big companies and their chieftains have come and gone, Welch has led GE to one revenue and earnings record after another. What can be inferred from th is case study is the fact that Jack Welch does it through sheer force of personality, coupled with an unbridled passion for winning the game of business and a keen attention to details many chieftains would simply overlook. He does it because he encourages near-brutal candor in the meetings he holds to guide the company through each work year. And he does it because, above all else, he’s a fierce believer in the power of his people. Welch likes to call GE the â€Å"grocery store.† The metaphor, however quirky for such a large firm, allows Welch to mentally roll up his sleeves, slip into an apron, and get behind the counter. There, he can get to know every employee and serve every customer.   Ã‚  Ã‚  Ã‚  Ã‚  After being extremely skeptical of quality programs, what’s going on at GE now is Six Sigma. Jack Welch felt that quality programs were too heavy on slogans and to short on results. Yet, Six Sigma is different. A Six Sigma quality level in a company like GE can save a company a great deal of money.

Primacy of Survival in Life of Pi

The urgent crave to survive at all costs is known as the primacy of survival. Survival is essential for every animal, and there is no shortage of lengths they will go to in order to survive. Yann Martel’s Life of Pi portrays the theme of primacy of survival based on Pi’s determination and courage throughout his journey. Piscine Molitor Patel, known to all as Pi, is a Hindu boy who embarks on a journey to Canada along with his family and their zoo animals. Midway through his journey, the boat sinks in the middle of the Pacific Ocean, and Pi is left stranded on a lifeboat.However, Pi is not alone on the raft; in his presence are a zebra, orangutan, hyena, and a fearsome Bengal tiger. Once he is aware of what happened, Pi understands that giving up on his life is not an option. This lust for survival is expressed by examining how all animals are naturally dangerous, how man will do cruel things in order to survive, and how all of our morals are lost when we feel threatened . Early on in Pi’s life, he is taught by his father that all animals are naturally dangerous.Pi’s father, who is the owner of a zoo in India doesn’t want Pi to be too comfortable around the animals at the zoo, since they could harm him if they feel threatened. In order to protect his son, he tells him â€Å"Life will defend itself no matter how small it is. Every animal is ferocious and dangerous. † (Martel, 41). This is crucial for Pi to understand, since he may think that some animals are harmless, meanwhile due to their natural instincts, they can be vicious if they feel threatened.However, after Pi’s father explains this to him he still isn’t convinced that Pi is fully aware of the consequences if he becomes too comfortable with the animals. Therefore he decides he needs to prove exactly how dangerous some of the animals can be. One day, he takes Pi and his brother to the big cats section of the zoo, to find a massive 550 pound female Be ngal tiger; the king of the jungle. He tells them how Mahisha, the tiger, hasn’t eaten in 2 whole days. Then, he says â€Å"I want you to remember this lesson for the rest of your lives† (Martel, 47). He then threw in a live goat into the tiger’s cage.With a sudden flash of orange and black fur, Mahisha demolished the goat with a single blow. Blood splattered everywhere, and Pi and his brother Ravi were utterly appalled by the sound of the dying goat. Pi himself is also an example of his father’s words that â€Å"Life will defend itself no matter how small it is. †( Martel, 41). Pi, a very skinny Hindu boy is faced alone with a hyena, orangutan, zebra and tiger on a lifeboat with no weapons. For the majority of his journey, he knows that death could be present at any given moment, but he still manages to protect and preserve himself.In certain situations, the primacy of survival of animals and humans alike can have an immensely powerful feeling, ur ging us to do anything in order to survive. This urge to survive can sometimes drive us to do cruel and unimaginable things. Pi experiences the cruelness of our hunger for survival when the boat Pi and his family are on begins to sink, and crew members throw Pi onto the lifeboat. Pi was thankful for them at first, since he thought being on the lifeboat would ensure his safety; however he wasn’t alone on the lifeboat.An adult hyena that was being shipped had managed to escape its cage and make refuge on the very same lifeboat as Pi! He soon realizes that the crew members didn’t throw him on the lifeboat to save his life, but rather as bait. Shocked, Pi says â€Å"They were using me as a fodder. They were hoping the hyena would attack me and that somehow I would get rid of it and make the boat safe for them. † (Martel, 121). This shows the extent to which humans will go to in order to survive, since there is ultimately nothing more drastic than human sacrifice. La ter on in Pi’s journey, he surprisingly runs into another lone survivor on another lifeboat.At this point in Pi’s journey, his body is severely dehydrated, and is beginning to deteriorate, which results in his loss of vision. The man on the other raft is blind as well, but once Pi begins to talk with him he is able to identify his accent as French. The man, much like Pi, hasn’t had food in days and is starving. Craving his own survival, the man attempts to attack and kill Pi for food. Pi is sure this is the end of his life, â€Å"I could feel him moving off the tarpaulin onto the middle bench and, fatally, bringing a foot down to the floor of the boat. ‘No, no, my brother! Don’t! We’re not-’ † (Martel, 283).Right before the man begins to attack Pi, Richard Parker; the mighty but weakened Bengal tiger on Pi’s lifeboat attacks the man and kills him. If it hadn’t been for Richard Parker, the man would have without a d oubt killed Pi and ate him in order to secure his own survival. Killing someone of the same species as you is sickening and cruel, but doing so to eat them is absolutely insane; something an animal would do. The truth is â€Å"We're animals. We're born like every other mammal and we live our whole lives around disguised animal thoughts. † (Morace, 1).Humans are essentially animals, but once separated from our race, faced with the possibility of death, we will do anything in order to survive. Not only will humans do unimaginable things in order to survive, their morals are all lost to a craving selfishness for survival. Pi experiences this first hand when the hyena on the lifeboat attacks the zebra and wounds it. He is initially horrified at this, but then he expresses how his sense of empathy was quickly overtaken in the fear of his own life: â€Å"When your own life is threatened, your sense of empathy is blunted by a terrible, selfish hunger for survival. † (Martel, 133).This is natural for humans, something that comes instinctualy to us. Later on, Pi feels remorse for the zebra, unlike how he felt in the moment. His instincts however could have saved his life, since he proceeded to hide once the hyena attacked instead of watching and mourning the zebra. Pi even knew that what happened was normal, and that it may have kept him alive. Before he set sail on the ship through the pacific, he learnt about this madness for survival, â€Å"All living things contain a measure of madness that moves them in strange, sometimes inexplicable ways. This madness can be saving; it’s part and parcel of the ability to adapt.Without it, no species would survive. † (Martel, 45). One may argue however that humans are different, that we should not turn into animals when we feel threatened. This is in fact false, since society is what holds us back: â€Å"Deprived of the zoo-like structures (society) that sustain them in their daily lives, humans retur n quite naturally to lives guided by basic instincts and animalistic impulses. † (Dominic, 143). Once Pi leaves society all together, he essentially becomes an animal like figure guided by instinct that only does things that are necessary for his survival. Because of Pi’s instincts, he is able to survive.Even though it may seem that Pi just witnesses these acts of human cruelty and loss of morals, he in fact suffers from the loss of morals and is extremely cruel himself. From as early on as he could remember in his life, Pi was a very strict vegetarian. Once he realized he was stranded on the life raft, he knew he would have to give up on his old habits, and that he would have to eat meat in order to survive. Pi quickly learns that he can’t be picky with the food he gets, and with his stomach rumbling of hunger, he proceeds to devour raw fish eyes, turtle blood and Pi even says that â€Å"I tried once to eat Richard Parkers feces.† (Martel, 237).He quickly learns that tiger feces isn’t suitable for humans to eat, and doesn’t attempt to eat it again. Even though it is entirely disgusting that he would do that, he didn’t have many more options. After these events it is said that â€Å"Pi also begins to recognize, much to his disappointment, that his own behaviours are becoming more animal-like† (Dominic, 143). Once Pi does realize that he is simply living off his instincts, he is surprisingly content with himself.However, on the verge of death, Pi does something that is questionable even in order to survive. One may wonder if there is anything worse that Pi could have done on his journey. The answer is cannibalism. After the man that Pi meets at sea is killed by Richard Parker, Pi actually eats some of the man’s raw flesh. Pi confesses that, â€Å"Driven by the extremity of my need and the madness to which it pushed me, I ate some of his flesh. † (Martel, 284). Having not eaten in nearly 12 day s, he even claims that â€Å"they slipped into my mouth nearly unnoticed. † (Martel, 284).This cruel, sickening and unacceptable act simply shows how we will do absolutely anything and everything in our power to survive. As a whole, the primacy of survival is thoroughly expressed within ample instances of Pi’s journey. What else could show the will to survive better than a teenage boy stranded alone on a lifeboat in the middle of the Pacific Ocean? Nothing, except if there perhaps was a giant Bengal tiger aboard. Well in that case Pi’s journey is the ultimate story of survival, since he faced hunger, thirst and death with the king of the jungle in his presence the entire time.Along his way, Pi learned how dangerous all animals naturally are, how humans can do such cruel things, and how our morals are lost when we are threatened. Some may speculate that what Pi did to survive is just plain wrong and unacceptable. Nevertheless Pi survived a record 227 days on the dreadful Pacific Ocean before his journey finally came to a close. From Pondicherry, India, all the way to Tomatlan, Mexico, Pi had to do many undesirable things that all point to an animal’s primacy of survival.