Saturday, August 31, 2019

Cause and Effect of Corruption

There is a growing worldwide concern over corruption at the present time. Several factors are responsible for this. A consensus has now been reached that corruption is universal. It exists in all countries, both developed and developing, in the public and private sectors, as well as in non-profit and charitable organizations. Allegations and charges of corruption now play a more central role in politics than at any other time. Governments have fallen, careers of world renowned public figures ruined, and reputations of well-respected organizations and business firms badly tarnished on account of it.The international mass media feeds on it and scandals and improper conduct, especially of those in high places. The rising trend in the use of corruption as a tool to discredit political opponents has brought scandalous and corrupt behavior to international attention. Corruption can be a major obstacle in the process of economic development and in modernizing a country. Many now feel that i t should receive priority attention in a country’s development agenda. This greater recognition that corruption can have a serious adverse impact on development has been a cause for concern among developing countries.In a recent survey of 150 high level officials from 60 third world countries, the respondents ranked public sector corruption as the most severe obstacle confronting their development process. Countries in the Asia and Pacific region are also very worried about this problem and they are in substantial agreement that corruption is a major problem that is hindering their economic, political and social development, and hence view it as a problem requiring urgent attention at the highest level. Increasing public interest and concern over corruption have resulted in a large amount of scholarly research on the subject.Admittedly, there are still wide gaps in the current state of information and knowledge on the matter and much more remains to be done. Nevertheless, the oretical and empirical research that has been conducted thus far has yielded fresh insights into the problem. We now have a clearer understanding of the underlying causes of corruption, its consequences, and ideas and approaches on possible measures to combat it. At the same time, a better perspective has been obtained on the reasons why corruption persists in so many countries, and why it is difficult to deal with, although people throughout he world view it with disfavor. It is a common practice in many developing countries to institute price controls and to provide essential goods and services at subsidized prices to consumers. The official price for a key food item, such as rice, is fixed by paying a low administratively set price to farmers, while gasoline, electricity and charges for public transport and other essential items are provided at low subsidized prices. These mostly benefit city dwellers as they are the main consumers of these subsidized goods and services.The urban bias in the provision of subsidized food and other necessities stems from the political reality that city dwellers, especially the large masses at the lower end of the income scale, are more politically conscious, better organized and are easier to be instigated into civil unrest than the rural poor. It is usually discontent in the cities that ignites social and political upheavals in a country. Fixing prices at artificially low levels lead to demand exceeding supply for the subsidized goods so that the all too familiar shortages, rationing, corruption and black markets result.Several undesirable consequences follow. There is a loss of potential government revenue. For example, when those that have access to subsidized gasoline, such as government officials and car owners, sell it on the black market at several times the official price, they make large profits. These profits could be taken as revenue by the government, if there is no subsidy, no price distortion, and gasoline is va lued at its true opportunity cost, that is, charged by the government at its market clearing price.Setting low farm prices on rice and other agricultural products, to provide cheap food for city dwellers, means farmers are subsidizing the people in the cities. Likewise, low prices set on gasoline and energy contributes to deficits in the government budget. Fixing low prices on rice and agricultural products, in the wake of sharp increases in the prices of other domestically produced and imported goods, turns the terms of trade against farmers. This adversely affects their incentive to produce and hinders agricultural output. Low prices set on energy result in huge losses for the government enterprises engaged in this area.Consequently, they do not have the resources to invest in new facilities, to buy spare parts or to properly maintain existing machinery, and equipment that are falling into disrepair. The outcome is frequent breakdowns, unreliable and poor service, and general inab ility to meet requirements in terms both of generating capacity and in the quality of energy produced. Under-pricing energy has other harmful effects. Cheap energy leads to its uneconomic and wasteful use. When energy prices are kept at a level much below cost for decades, there is little incentive for its users to adopt energy efficient technologies and methods of production.So they are not sufficiently prepared for the large price adjustment that inevitably comes when low prices are no longer sustainable due to an internal or an external shock. The result is disruption in production, more corruption as bribery will be resorted to order to avoid payment of the higher charges, and increased inflationary pressures as higher energy costs will be passed on to consumers by raising prices. Thus, price controls, subsidies and the corruption and black markets they generate, can lead to undesirable social and economic consequences.This also illustrates the point that dismantling controls, g etting rid of subsidies and preventing price distortions form a key element in economic reforms and for the establishment of a properly functioning market economy. Unfortunately, corruption places severe constraints on a country’s capacity to undertake economic reforms. The rich and the powerful, the main gainers of a corrupt system, will therefore oppose reforms. The leadership in a country has a key role to play in combating corruption. It is an Asian tradition to hold leaders and those in authority in high regard and esteem.Hence the top leadership must set a good example with respect to honesty, integrity and capacity for hard work. Since fighting corruption will involve taking difficult decisions, the leadership must also display firmness, political will and commitment to carry out the required reforms. Honest and dedicated leaders are an essential, but not a sufficient, condition to counter corruption. Several other conditions are needed as well. Credibility is one of t hem. For success, the offenders both on the demand and supply side of a corrupt deal must be convinced that the government is serious about fighting corruption.Publicly try and punish some well-known corrupt people in the country. Some highly publicized trials and convictions of important officials and businessmen on charges of corruption have taken place in several countries. A publicity campaign to create greater awareness on the adverse effects of corruption and a clear and unmistakable official announcement on the desirability to bring it under control would be helpful. Ordinary citizens have a lot of firsthand experience with corruption, they are a good source of information and their help and cooperation should be solicited for the successful launch of an anti-corruption drive.Once people are convinced that a sincere and genuine effort to combat corruption is underway, they will respond and extend their full cooperation in resolving the problem. Just a little opening up and pr oviding opportunities for them to express their views on the matter will bring forth an outpouring of information, ideas and suggestions. A responsible press to gather, analyze, organize, and present information is considered vital to create greater public awareness and to provide the momentum for undertaking reforms to overcome corruption.Secretiveness has been a key factor that has enabled public officials and politicians to get away with corruption. A responsible and an investigative press has played an important role in many countries, both developed and developing, in exposing misconduct as well as in serving as a watchdog to limit corruption and preventing it from getting out of hand. The press has not always acted in a responsible manner, and like everything else in this world, it is not perfect. Nevertheless, its power to limit misconduct and improper behavior should not be underestimated.Views on the effectiveness of anti-corruption oversight or watchdog bodies are mixed. T here are instances where they have proved useful. However, in surveys and interviews of public officials and members of civil society organizations, most respondents do not have a high opinion of them. Improving institutions involves such things as improving the legal framework, promoting efficiency of the police force, strengthening the auditor general’s office, and appointment of a responsible inspector general empowered to investigate and prosecute corruption.A useful conclusion that has emerged from the current discussion and ongoing debate on the corruption issue is that corruption is a symptom of economic, political, and institutional weaknesses in a country. To be effective, measures against corruption must therefore address these underlying causes and not the symptoms. Emphasis must be placed on preventing corruption by tackling the root causes that give rise to it through undertaking economic, political and institutional reforms.Anti-corruption enforcement measures s uch as oversight bodies, a strengthened police force and more efficient law courts will not be effective in the absence of a serious effort to address the fundamental causes. Another observation that may be useful to bear in mind is that corruption is most prevalent where there are other forms of institutional weaknesses, such as political instability, bureaucratic red tape, and weak legislative and judicial systems. The important point is that corruption and such institutional weaknesses are linked together and that they feed upon each other.

Friday, August 30, 2019

Case Study – Appendicitis

I. DEFINITION/PREVALENCE Acute disease of the GI tract may be caused by the pathogen itself or by a bacterial or other toxin. Acute inflammatory disorders such as appendicitis and peritonitis result from contamination of damaged or normally sterile tissue by a client’s own endogenous or resident bacteria (Lemone and Burke, 2008, page 766). Appendicitis is the inflammation of the vermiform (wormlike) appendix; the appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve, which is the beginning of the large intestine.It is usually located in the right iliac region, at an area designated as McBurney’s point. McBurney’s point, located midway between the umbilicus and the anterior iliac crest in the right lower quadrant. It is the usual site for localized pain and rebound tenderness due to appendicitis during later stages of appendicitis. The function of the appendix is not fully understood, although it reg ularly fills and empties digested food. Some scientists have recently proposed that the appendix may harbor and protect  bacteria  that are beneficial in the function of the human colon.Appendicitis  is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. The lower quadrant pain is usually accompanied by a low-grade fever, nausea, and often vomiting. Loss of appetite is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burney’s point applied located at halfway between the umbilicus and the anterior spine of the Ilium. Rebound tenderness (ex. Production or intensification of pain when pressure is released) may be present.The extent of tenderness and muscle spasm and the existence of the constipation or diarrhea depend not so much on the severity of the appendiceal infection as on the location of the appendix. If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. Rovsing’s sign may be elicited by palpating the left lower quadrant. If the appendix has ruptured, the pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patient’s condition worsens.The disease is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates. It is the most common reason for emergency abdominal surgery, affecting 10% of the population. Although appendicitis affects a person at any age, the peak incidence is between the ages of 20 and 30 years old in which the vast majority of clients are most common in adolescents and young and slightly more common in males than females. About 7% of the population will have appendicitis at some time in their lives (Lemone and Burke, 2008 page 766).The major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal Pyle phlebitis , which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines. Perforation generally occurs 24 hours after the onset of pain symptoms include a fever of 37. 7 degree Celsius or 100 degree Fahrenheit or greater, a toxic appearance and continued abdominal pain or tenderness. II. TYPES/CLASSIFICATIONAppendicitis can be classified as simple, gangrenous, or perforated, depending on the stage of the process. In simple appendicitis, the appendix is inflamed but intact. When areas of tissue necrosis and microscopic perforations are present in the appendix, the disorder is called gangrenous appendicitis. A perforated appendix shows evidence of gross perforation and contamination of the peritoneal cavity (LeMone & Burke, 2008 page 766). Peritonitis can be primary or secondary. Primary peritonitis is an acute bacterial infection that is not associated with perforated viscus, or organ.Bacterial infection is the usual cause and may be associated wi th an infection by the same organism somewhere else in the body, which reaches the peritoneum via the vascular system. Tuberculosis peritonitis, which originates from tuberculosis elsewhere in the body, is a type of primary peritonitis. Clients with alcoholic cirrhosis and ascites, in the absence of a perforated organ, often manifest peritonitis, which may be due to leakage of bacteria through the wall of the intestine. Secondary peritonitis is usually caused by bacterial invasion as a result of perforation, or rupture of an abdominal viscus.It can also result from severe chemical reactions to: pancreatic enzymes, digestive juices, or biles released into the peritoneal cavity (Gould & Dyer, 2011). III. DEMOGRAPHIC PROFILE Patient’s name is Mr. Ruptured Acute Appendicitis, 24 years old, male, residing at 820 General Kalentong, Daang Bakal, Mandaluyong City. He is the second child among 3 siblings, a Roman Catholic, single, a 3rd year college Information Technology student. IV. FAMILY MEDICAL HISTORY (Family Genogram)COD: TB COD: TB A: 83 -S, -D A: 83 -S, -D Not Recalled Not Recalled c c A: 20 +S, +D A: 20 S, +D A: 24 +S, +D A: 24 +S, +D A: 27 -S, -D Skin allergy A: 27 -S, -D Skin allergy A: 42 +S, +D A: 42 +S, +D A: 64 +S, +D HPN, Stroke A: 64 +S, +D HPN, Stroke c c A: 46 -S, +D Asthma A: 46 -S, +D Asthma A: 51 -S, +D A: 51 -S, +D patient patient LEGEND: LEGEND: male male married married deceased male deceased male S- smoker D- drinker COD- cause of death S- smoker D- drinker COD- cause of death female female deceased female deceased female V. PAST MEDICAL HISTORY He was first hospitalized last 2006 due to dengue at the same hospital: Mandaluyong City Medical Center (MCMC).He has no other further illnesses except the typical fever, cough and cold. Other than that, he has no allergies, hypertension, or diabetes mellitus. VI. HISTORY OF PRESENT ILLNESS 1 week prior to admission patient experienced abdominal pain all over abdomen. He consulted at ER MCMC si gned out AUPD (Acute Peptic Ulcer Disease) and was given Omeprazole & HNBB (Buscopan). Whole abdominal ultrasound done and revealed tiny cholecystolethiasis. He was given Diclofenal and HNBB tab and eventually discharged. Few days prior to consultation, the patient still experienced abdominal pain.He consulted at Emergency Room and was opted for surgical intervention – EXPLORATORY LAPAROTOMY APPENDECTOMY under the service of Dr. Abram Del Valle, M. D. VII. GORDON’S PHYSICAL ASSESSMENT i. Health Maintenance – Perception Pattern Before admission: The patient used to smoke cigarette 3 sticks per day. And he also drinks alcohol daily specifically beer of more than 2 bottles per session. He was not using drugs and he has no allergies at all. During time of care: The patient is not smoking cigarette or drinking alcohol. ii. Nutritional – Metabolic PatternBefore admission: The patient was on a high protein diet because he was used to go to the gym 2-3 times a we ek. He was also taking vitamins (CENTRUM). He has normal appetite and has no difficulty swallowing. He usually eats 3 times a day (breakfast, lunch and dinner) and most of the time he also has his snacks. He also usually drinks 2-3 liters of water a day. e During time of care: The patient is on NPO (nothing per orem) for 5 days due to post-operative appendectomy and he was on his 2nd day of NPO status when we cared for him. He has also NGT lavage connected. ii. Elimination Pattern Before admission: The patient’s normal bowel movement was 3 BM a day and has no difficulty in bladder habits. His last bowel movement was last July 17, 2012. He usually urinates 6-7 times a day without difficulty. During time of care: The patient has absence of bowel movement and even flatus and has no bowel sounds upon auscultation. He has foley catheter and with urine output of 480 cc per shift. iv. Activity and Exercise Before admission: The patient could do his activities independently without a ssistance.He usually goes to gym 2-3 times a week. During time of care: The patient’s functional level or self-care ability level is 2 which mean he requires help from another person for assistance. v. Sleep/Rest Pattern Before admission: The patient usually sleeps at 4 or 5 am and wakes up at 8 or 9 am. He has no difficulty in sleeping and he feels rested after sleep. During time of care: The patient has regular sleeping habits. He sleeps at 10 am, wakes up at 6 am with uninterrupted sleep. vi. Cognitive – Perceptual PatternBefore admission: The patient was alert and coherent, has normal speech, with mild level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. During time of care: The patient is alert and coherent. He has normal speech (Filipino as his spoken language), he has moderate level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. He also complained of acute pain and described it as a cramping pain. Pain management (Tramadol) was given. vii. Role – Relationship Pattern Before admission: The patient was a student and single.His support system was his family, relatives & friends. During time of care: The patient’s support system is his mother who is always at his bed side assisting him in whatever he needs. Upon asking his mother if she has any concerns regarding hospitalization, she said that she is more concern about the fast recovery of her son. viii. Sexuality – Reproductive System Before admission and during the time of care: The patient still didn’t have his testicular exam. ix. Coping – Stress Tolerance/Self – Perception/Self – Concept Pattern The patient’s major concern regarding his hospitalization is s all about self-care.Due to the contraptions attached to him, he cannot independently do his activities. His major loss was his stepfather when he died of kidney failure. His rated his outlook on future as 5, 1 being poor and 10 being very optimistic. He further explained why he rated 5 because he is not sure if when he finished college he can be able to find a job suited for him. x. Value – Belief Pattern Our patient is a Roman Catholic and he always goes to church every Sunday together with his family. VIII. GROWTH AND DEVELOPMENT DEVELOPMENTAL TASK| THEORIST| STATUS| Intimacy vs.Isolation * Develops commitments to others and to a life work (career)(Daniels, et. al. , 2010). | Erikson| The patient had a relationship with his opposite sex but he said that they just broke up a week before he was hospitalized due to some personal and private reasons. Currently, he is in 3rd year college, an IT student. | Genital * Emergence of sexual interests and development of relationships with potential sexual partners (Daniels, et. al. , 2010). | Freud| As what had written above, the patient had a relationship with his opposite sex but because of some reasons they decided to end u p their relationship. Formal Operations * Able to see relationships and to reason in the abstract (Daniels, et. al. , 2010). | Piaget| He perceived that relationships (any kind of relationship) are important especially at his age. He can also reason out in an abstract way. He can express his opinions intellectually and precisely. | Early Adulthood * Select a partner, learn to live with a partner, start a family, manage a home, establish self in a career/occupation, assume civic responsibility, and become a part of a social group (Daniels, et. al. , 2010). Havighurst| According to our patient, he didn’t expected that something like that will happen to them (referring to his girlfriend). He was really expecting that they are really meant for each other and that she (his gf) will be his future wife. He is also establishing himself to a future career, that’s why he is studying in preparation for his future. During our time of care also, his ‘barkadas’ visited him and he said that they were his ‘tropa’. | Postconventional * Individual understands the morality of having democratically established laws (Daniels, et. al. , 2010). Kohlberg| Upon asking the patient if he is familiar with the democratically established laws in the Philippines, he immediately responded with a yes. He also said that these laws help us, Filipinos, to have safe and secure country though there may come a time that we may experience something unexpectedly. | IX. PHYSICAL ASSESSMENT * Vital Signs TIME| Initial 8AM (07/24/12)| 10 AM| 12 NN| 8 AM (07/25/12)| 12 NN| Last 8AM(07/26/12)| T| 36. 3| 37. 3| 37. 4| 36. 4| 37. 3| 36| P| 83| 84| 71| 75| 81| 68| R| 23| 25| 21| 19| 19| 20| BP| 120/80| 120/80| 120/80| 120/80| 120/80| 110/80| Sequence: BY SYSTEMS NORMAL FINDINGS| BOOK FINDINGS| PATIENT FINDINGS| SIGNIFICANCE| I. NEUROLOCIGAL SYSTEM Alert and coherent; with normal body temperature of 36. 3 °C – 37. 6 °C| * Fever (usually >38 °C although hypo thermia may be present w/ severe sepsis); chills * Thirst * Pain| * Complained of pain in the incision site (lower longitudinal midline of the abdomen)| Pain results from the increased pressure of fluid on the nerves, especially in enclosed areas, and by the local irritation of nerves by chemical mediators such as bradykinins (Gould, et al. 2011). | II. RESPIRATORY Normal respiration with a rate of 12-20 breaths per minute| * Tachypnea; shallow respirations| * RR: 23 bpm w/ shallow respiration| Acute pain usually initiates physiologic stress response with increased respiratory rate (Gould & Dyer, 2011). | III. INTEGUMENTARYPink or brown and in uniform color, no edema, no lesions, moistSkin temperature is normally warmIntact skinWhen pinched, skin springs back to previous state| * Dry lips and mucous membranes * Swollen tongue * Poor skin turgor| * Dry lips and mucous membranes * Skin turgor:3-5 seconds * Presence of surgical incision at lower longitudinal midline of the abdomen * Sk in is warm to touch and is reddened| Dry mucous membrane and poor skin turgor are signs of dehydration (Gulanick, et al. 1994). Redness may indicate inflammation (Weber & Kelly, 2007). Redness and warmth are caused by increased blood flow into the damaged area (Gould & Dyer, 2011). | IV. CARDIOVASCULAR Normal pulse rate of 60-100 bpm| * Tachycardia * Diaphoresis * Pallor * Hypotension * Tissue edema| * Pulse rate: 83 bpm| Acute pain usually initiates a physiologic stress response with increased heart rate (Gould & Dyer, 2011). | V. MUSCOLOSKELETALAbility to do Activities of Daily Living (ADL)| * Difficulty ambulating * Weakness| * Difficulty ambulating due to post-op condition * Weakness| Constant pain frequently affects daily activities and may become a primary focus in the life of an individual (Gould & Dyer, 2011). | VI. GENITO-URINARY Normal urine output of 30cc/hrColor: Amber, transparent, clear| * Decreased urinary output * Dark color urine| * Dark color urine * Urine output: 480 mL/shift * Specific gravity: 1. 30| Decreasing output of concentrated urine with increasing specific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). | VII. GASTROINTESTINAL Abdominal skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elementsAbdomen is free of lesions or rashesA series of intermittent, soft clicks and gurgles are heard at a rate of 5-30 per minuteNormally no tenderness or pain is elicited or reported by the clientNo rebound tenderness is presentAbdomen is non-tender and soft.There is no guarding| * Loss of appetite * Nausea & vomiting(usually projectile) * Constipation of recent onset * Diarrhea(occasional) * Sudden, severe, generalized abdominal pain * Abdominal distention; rigidity * Decreased/absence of bowel sounds * Inability to pass stool/flatus * Muscle guarding (abdomen) * Psoas’ Sign (flexion of or pain on hyperextension of the hip due to contact between an inflammat ory process & the psoas muscle) * Obturator Sign (the internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee and a resultant tightening of the internal obturator muscle may ause abdominal discomfort) * Rovsing’s Sign (pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant) * Rebound tenderness (a sign of inflammation of the peritoneum in which pain is elicited by the sudden release of the fingertips pressing on the abdomen) | * Board-like abdomen * Sudden, severe, generalized abdominal pain * Absence of bowel sounds in all four quadrants * Absence of flatus/stool * Presence of surgical incision| Signs indicating the onset of peritonitis include a rigid â€Å"board-like† abdomen (Gould & Dyer, 2011).Pain recurs as a steady, severe abdominal pain as peritonitis develops (Gould & Dyer, 2011). Absence of bowel sounds may be associated with peritonitis or paralytic ileus (Weber & Kelly, 2007). When inflam mation persists, nerve conduction is impaired, and peristalsis decreases, leading to obstruction of the intestines (paralytic ileus) (Gould & Dyer, 2011). | X. DIAGNOSTIC TESTS DIAGNOSTIC TEST| NORMAL| RESULT| SIGNIFICANCE| WHOLE ABDOMINAL ULTRASOUND (July 21, 2012) | The organs examined appear normal (Cosgrove, et al. , 2008). | Liver is not enlarged.It has homogenous echopattern with smooth border. The intrahepatic ducts are not dilated. No evident focal mass lesion seen. CD measures 3. 9mm. Gallbladder is normal in size and wall thickness. There are multiple tiny echogenic shadowing foci seen within the gallbladder lumen. Pancreas & spleen are normal in size & echopattern. No focal mass lesion seen. Both kidneys are normal in size & echopattern. Right kidney measures 10. 1Ãâ€"4. 2Ãâ€"5. 46cm with cortical thickness of 1. 7cm while the left kidney measures 10. 5Ãâ€"4. 8Ãâ€"4. 1cm with thickness of 19cm. No evident caliectasis, lithiasis, seen bilaterally.Urinary bladder is unf illed. Impression:Tiny cholecystolithiasesNormal liver, pancreas, spleen, kidneys by UTZUnfilled urinary bladderNot dilated biliary tree | Abdominal ultrasound is the most effective test for diagnosing acute appendicitis (LeMone & Burke, 2007). | HEMATOLOGY REPORT/COUNT (July 21, 2012)| RBC: 4. 2-5. 6 M/uLPlatelets: 150-400 x 10/LWBC: 3. 8-11. 0 K/mm3Hemoglobin: 135-180g/LHematocrit: 0. 45-0. 52DifferentialNeutrophils: 0. 50-0. 81Lymphocytes: 0. 14-0. 44Monocytes:0. 02-0. 06Eosinophils: 0. 01-0. 05Basophils:0. 00-0. 01| WBC Count: 12. 6 K/mm3RBC: 4. 1 M/uL (normal)Hematocrit: 0. 45 (normal)Hemoglobin: 153g/L (normal)Differential Count:Neutrophils 0. 90Lymphocytes 0. 10 (normal)| Elevated WBC is seen in acute infection (LeMone & Burke, 2007). Neutrophils: elevated in bacterial infection (LeMone & Burke, 2007). | URINALYSIS (July 21, 2012)| Color: Light straw to amber yellowAppearance: ClearOdor: AromaticpH: 4. 5-8. 0Specific gravity: 1. 005-1. 030Protein: 2-8mg/dLGlucose: NegativeKet ones: NegativeRBCs: RareWBCs: 3-4Casts: Occasional hyaline| Color: Dark YellowTransparency: TurbidUrine pH: 6. 0 Specific gravity: 1. 30Sugar: NegativeProtein: +4Microscopic examPus cells 4-6/HPFRBC 1-2/HPFCrystals: Amorphous Sulfate Moderate| A dark yellow to brownish color is seen with deficient fluid volume (LeMone & Burke, 2007). Hazy or cloudy urine indicates bacteria, pus, RBCs, WBCs, phosphates, prostatic fluid spermatozoa, or urates (LeMone & Burke, 2007). | CLINICAL CHEMISTRY (July 21, 2012)| Sodium (Na): 135-142 mmol/LPotassium (K): 3. 8-5 mmol/L| Sodium: 132 mmol/LPotassium: 4. 02 mmol/L| Sodium is decreased in SIADH & vomiting (LeMone & Burke, 2007). | XI. ANATOMY & PHYSIOLOGY OF APPENDIX (LARGE INTESTINE)The large intestine, which is about 1. 5 m (5 ft) long and 6. 5 cm (2. 5 in. ) in diameter, extends from the ileum to the anus. It is attached to the posterior abdominal wall by its mesocolon, which is a double layer of peritoneum. Structurally, the four major regions o f the large intestine are the cecum, colon, rectum, and anal canal. The opening from the ileum into the large intestine is guarded by a fold of mucous membrane called the ileocecal sphincter (valve), which allows materials from the small intestine to pass into the large intestine. Hanging inferior to the ileocecal valve is the cecum, a small pouch about 6 cm (2. 4 in. ) long.Attached to the cecum is a twisted, coiled tube, measuring about 8 cm (3 in. ) in length, called the appendix or vermiform appendix (vermiform = worm-shaped; appendix = appendage). The mesentery of the appendix, called the mesoappendix, attaches the appendix to the inferior part of the mesentery of the ileum. The open end of the cecum merges with a long tube called colon, which is divided into ascending, transverse, descending colon are retroperitoneal; the transverse and sigmoid colon ascends on the right side of the abdomen, reaches the inferior surface of the liver, and turns abruptly to the left to form the right colic (hepatic) flexure.The colon continues across the abdomen to the left side as the transverse colon. It curves beneath the inferior end of the spleen on the left side as the left colic (splentic) flexure and passes inferiorly to the level of the iliac crest as the descending colon. The sigmoid colon begins near the left iliac crest, projects medially to the midline, and terminates as the rectum at about the level of the third sacral vertebra. The rectum, the last 20 cm (8 in. ) of the GI tract, lies anterior to the sacrum and coccyx. The terminal 2-3 cm (1 in. ) of the rectum is called the anal canal.The mucous membrane of the anal canal is arranged longitudinal folds called anal columns that contain a network of arteries and veins. The opening of the anal canal to the exterior, called the anus, is guarded by an internal anal sphincter of smooth muscle (involuntary) and an external anal sphincter of the skeletal muscle (voluntary). Normally these sphincters keep the anus c losed except during the elimination of feces (Tortora & Derrickson, 2006). XII. PATHOPHYSIOLOGY NARRATIVE Appendicitis, inflammation of the vermiform appendix, is a common cause of acute abdominal pain.It is the most common reason for emergency abdominal surgery, affecting 10% of the population (Tierney et al. , 2005). Appendicitis can occur at any age, but is more common in adolescents and young adults and slightly more common in males than females (LeMone & Burke, 2007). The development of appendicitis usually follows a pattern that correlates with the clinical signs, although variations may occur because of the altered location of the appendix or underlying factors (Gould & Dyer, 2011). Obstruction of the proximal lumen of the appendix is apparent in most acutely inflamed appendices.The obstruction is often caused by fecalith, or hard mass of feces. Other obstructive causes include a calculus or stone, a foreign body, inflammation, a tumor, parasites (e. g. , pinworms), or edema of lymphoid tissue (LeMone & Burke, 2007). Following obstruction, the appendix becomes distended with fluid secreted by its mucosa and microorganisms proliferate. Pressure within the lumen of the appendix increases, impairing its blood supply because blood vessels in the wall are compressed thus the appendiceal wall becomes inflamed and purulent exudate forms.Within 24 to 36 hours, the increasing congestion and pressure within the appendix leads to ischemia and necrosis of the wall, resulting in increased permeability. Bacteria and toxins escape through the wall into the surrounding are. This breakout of bacteria leads to abscess formation or localized peritonitis. An abscess may develop when the adjacent omentum temporarily walls off the inflamed area by adhering to the appendiceal surface. In some cases, the inflammation and pain subside temporarily but then recur. Localized infection or peritonitis develops around the appendix and may spread along the peritoneal membranes.Increas ing pressure inside the appendix causes increased necrosis and gangrene in the wall (infection in necrotic tissue). The wall of the appendix appears blackish. The appendix ruptures or perforates, releasing its contents into the peritoneal cavity. This leads to generalized peritonitis and would lead to septicemia and into septic shock and will result to death (Gould & Dyer, 2011). XIII. PATHOPHYSIOLOGY DIAGRAM Risk Factors Non-modifiable: * Age (Adolescents & young adults) * Gender (Male) Modifiable: * Fecalith * Calculus/Stone * Foreign body * Inflammation * Tumor * Parasites Edema of lymphoid tissue Obstruction of the appendiceal lumen Obstruction of the appendiceal lumen Buildup of fluid inside the appendix Buildup of fluid inside the appendix Proliferation of microorganisms Proliferation of microorganisms Abdominal pain Abdominal pain Increased pressure within the lumen of appendix Increased pressure within the lumen of appendix Compression of blood vessels Compression of blood v essels * Fever * Obturator Sign * Psoas Sign * Rovsing’s Sign * Rebound tenderness * Fever * Obturator Sign * Psoas Sign * Rovsing’s Sign * Rebound tenderness Decreased blood flow into the appendixDecreased blood flow into the appendix Inflammation of appendiceal wall Inflammation of appendiceal wall (July 21, 2012) Hematology Count * WBC count: 12. 6 K/mm * Neutrophils: 0. 90 Urinalysis * Transparency: turbid (July 21, 2012) Hematology Count * WBC count: 12. 6 K/mm * Neutrophils: 0. 90 Urinalysis * Transparency: turbid Ischemia & necrosis of the wall Ischemia & necrosis of the wall Increased permeability Increased permeability Bacteria and toxins escape through the wall Bacteria and toxins escape through the wall Abscess formation/localized bacterial peritonitisAbscess formation/localized bacterial peritonitis Proliferation of localized peritonitis around the appendix and peritoneal membranes Proliferation of localized peritonitis around the appendix and peritoneal me mbranes Increased pressure inside the appendix Increased pressure inside the appendix * Sudden, severe, generalized abdominal pain * Abdominal distention & rigid â€Å"boardlike† abdomen * Absence of bowel sounds/(-) flatus/(-) BM (July 24, 2012) * Sudden, severe, generalized abdominal pain * Abdominal distention & rigid â€Å"boardlike† abdomen * Absence of bowel sounds/(-) flatus/(-) BM July 24, 2012) Increased necrosis and gangrene in the wall Increased necrosis and gangrene in the wall Appendectomy with NGT lavage (July 22, 2012) Appendectomy with NGT lavage (July 22, 2012) Perforation of the appendix Perforation of the appendix Intestinal bacteria leak out into peritoneal cavity Intestinal bacteria leak out into peritoneal cavity * Low-grade fever & leukocytosis * Tachycardia * Hypotension * Vomiting * Low-grade fever & leukocytosis * Tachycardia * Hypotension * Vomiting Generalized peritonitis Generalized peritonitis XIV. NURSING PROCESSProblem #1: ABDOMINAL PAIN – July 24, 2012 * Subjective Cues: * â€Å"Nurse wait lang, ang sakit kasi parang nagcacramps,† patient verbalized while having a conversation with him. How does it feel like: Abdominal cramping Precipitating factor: â€Å"Kapag nililinisan pero kadalasan bigla-bigla na lang sumasakit† (â€Å"Whenever wound cleaning is performed but oftentimes it just suddenly happened†) Relieving factor: Pain reliever (but not all the time pain reliever is being given) Does it radiate to the other parts of the body (back, legs, chest, etc): No Duration of pain: â€Å"Paiba-iba din eh.Minsan sobrang tagal mga 2-3 minutes, minsan naman mga ilang Segundo lang† (â€Å"It differs, sometimes it’s too long (2-3 minutes) and sometimes it just happened for a second†) * Patient rated the pain as 8/10 where 0 signifies no pain and 10 signifies unbearable pain. * Objective Cues: * Facial grimace * Guarding of the incision site * Rigid (board-like) abdomen * Abd ominal distention * Location of pain: Surgical site * RR: 25 bpm * Nursing Diagnosis Acute Pain related to inflammation of the tissues secondary to post-op surgical incision.Inflammation or nerve damage gives rise to changes in sensory processing at peripheral and central level with a resultant sensitization. In relation, prostaglandins are chemotactic substances drawing leukocytes to the inflamed tissue. It plays a vasoactive role; it is also a pain and fever inducer (Lemone and Burke, 2007). Acute Pain related to infection & inflammation of the peritoneal membranes secondary to peritonitis The peritoneum consists of a large sterile expanse of highly vascular tissue that covers the viscera and lines of abdominal cavity.This peritoneal structure provides a mean of rapid dissemination of irritants or bacteria throughout the abdominal cavity. Abdominal distention is evident, and the typical rigid, board-like abdomen develops as reflex abdominal muscle spasm occurs in response to invol vement of the parietal peritoneum (Gould & Dyer, 2011). * Goal/NOC: Pain Control Outcomes Short Term: After 30 minutes of nursing intervention the patient will report a decrease in pain from pain scale of 8/10 to 4-5/10. Long Term:After 8 hours of nursing intervention the patient will demonstrate an understanding about the proper way of controlling pain as evidenced by proper splinting and deep breathing exercise and will report a decrease or most probably will be free from pain from pain scale of 4-5/10 to 1-2/10. * NIC: Pain Management Independent: * Assessed pain including its character, location, severity, and duration. Both preoperatively and postoperatively, the client’s pain provides important clues about the diagnosis and possible complications.Abdominal distention and acute inflammation contribute to the pain associated with peritonitis. Surgery further disrupts abdominal muscles and other tissues, causing pain (LeMone & Burke, 2007). * Monitored vital signs every 2 hours. Vital Signs, especially respiratory rate (RR), are usually altered in acute pain. (Sparks and Taylor, 2005). * Kept the client at rest in semi-Fowler’s position. Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position (Doenges et al. , 2006). * Provided diversional activities (texting, sound trip, etc).Refocuses attention, promotes relaxation, and may enhance coping abilities and diverts attention from pain (Doenges et al. , 2006). * Taught post-op health teaching (e. g. , proper splinting & deep breathing exercises). The use of non-invasive pain relief measures can increase the release of endorphins and enhance the therapeutic effects of pain relief medications (LeMone & Burke, 2007). * Encouraged early ambulation. Promotes normalization of organ function; stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). Give hot and cold compress. Hot , moist compresses have a penetrating effect. The warm rushes blood to the affected area to promote healing. Cold compresses may reduce total edema and promote some numbing, thereby promoting comfort. (Doenges et al. , 2006). Dependent: * Administered analgesic as prescribed (TRAMADOL 50 mg/IV Q 8 ° x 3 doses) Time given: 8 AM. Post-operatively, analgesics are provided to maintain comfort and enhance mobility (LeMone & Burke, 2007). * Kept on NPO. Decreases discomfort of early intestinal peristalsis and gastric irritation/vomiting (Doenges et al. 2006). * Evaluation Short Term: Goal partially met. After 30 minutes of nursing intervention the patient reported of a decrease in pain from a pain scale of 8/10 to 6/10 in which 4-5/10 was the expected outcome. Long Term: Goal met. After 8 hours of nursing intervention the patient displayed control of pain as evidence by deep breathing exercise and proper splinting. He also reported of a decrease in pain with a pain scale of 2/10 from 6/ 10. Pain reliever – TRAMADOL was given @ 8 am via IV. Problem #2: ABSENCE OF FLATUS– July 24, 2012 * Subjective Cues: â€Å"Nurse wait lang, ang sakit kasi parang nagcacramps (referring to abdominal cramping),† patient verbalized while having a conversation with him. * Pain scale of 8/10 * Objective Cues: * (-) Flatulence * (-) BM (Last BM was July 17, 2012) * Absence of bowel sounds upon auscultation of all four quadrants * Nursing Diagnosis Dysfunctional gastrointestinal motility related to inflammatory process of peritonitis secondary to absence of flatulence. The inflammatory process of peritonitis often draws large amounts of fluid into the abdominal cavity and the bowel.In addition, peristaltic activity of the bowel is slowed or halted by the inflammation, causing paralytic ileus, impaired propulsion of forward movement of bowel contents (LeMone & Burke, 2007). * Goal/NOC: Ambulation Outcomes Short Term: After 8 hours of nursing intervention the client wil l report/experience flatus and will understand and demonstrate the need for early ambulation following abdominal surgery. Long Term: After 2 days of nursing intervention the client will report/experience either flatus or bowel movement or both. * NIC: Impaction Management; PositioningIndependent: * Assessed abdomen including all four quadrants noting character to determine increased or decreased in motility; Assessed for further abdominal tenderness & auscultated for any abdominal sounds. To help identify the cause of the alteration and guide development of nursing intervention (Sabol & Carlson, 2007). * Monitored and recorded (intake) and output every hour or 2 hours. Intake and output records provide valuable information about fluid volume status (LeMone & Burke, 2007). * Encouraged early ambulation.Promotes normalization of organ function; stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). * Assisted in moving from side to side o r up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. (Gulanick, et. al. , 1994). Dependent: * Administered antacid as ordered (RANITIDINE 50g/IV Q 12 °. Antacids either directly neutralize acidity, increasing the  pH, or reversibly reduce or block the secretion of acid by gastric cells to reduce acidity in the stomach (Gabriely, et al. 2008). * Evaluation Short Term: Goal partially met. After 8 hours of nursing intervention the patient didn’t experience flatus or even bowel movement but was able to have an understanding with regards to early ambulation as evidenced by letting his mother assist him in moving up in bed going to the chair but refused to walk because of complaint of having a lot of contraptions attached to him which causes him to have difficulty in moving. Long Term: Goal met. After 3 days of nursing intervention the patient reported of a flatus fo r 3 times.Problem #3: RISK FOR DEHYDRATION – July 24, 2012 * Subjective Cue: * â€Å"Nanghihina na ako kasi limang araw ako hindi pwede kumain pati tubig bawal din kaya nagnunuyo na yung labi ko,† as verbalized by the patient. * Objective Cues: * NPO for 5 days * Dry mucous membrane * Dry lips * Capillary refill= 2 seconds * Skin turgor= 3-5 seconds * Urine output/shift= 480 mL * Urine color: Dark Yellow * Urine specific gravity: 1. 030 (Normal value: 1. 005-1. 030) * Absence of bowel sounds of all the four quadrants * (-) Flatus, (-) BM * BP: 120/80 mmHg * PP: 83 bpm * Nursing DiagnosisRisk for deficient fluid volume related to postoperative restriction secondary to NPO for 5 days Inflammation of the peritoneum with sequestration fluid and NPO status can lead to dehydration and electrolyte imbalance (Doenges, et al. , 2008). * Goal/NOC: Knowledge: Treatment Regimen; Hydration; Oral Hygiene; Tissue Integrity: Skin & Mucous Membranes Outcomes Short Term: After 30 minute s of nursing intervention patient will have an understanding with regards to maintaining fluid balance as evidenced by willingness of following the prescribed regimen given by the medical staffs. Long Term:After 3 days of nursing intervention the patient will be able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor, stable vital signs, and individually adequate urine output. * NIC: Fluid Management; Fluid Monitoring; Vital Signs Monitoring Independent: * Monitored BP & Pulse. Variations help identify fluctuating intravascular volumes, or changes in vital signs associated with immune response to inflammation (Doenges, et al. , 2006). * Inspected mucous membranes; assessed skin turgor and capillary refill. Indicators of adequacy of peripheral circulation and cellular hydration (Doenges, et al. 2006). * Monitored intake and output; noted urine color/concentration, specific gravity. Decreasing urine output of concentrated urine with increasing s pecific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). * Auscultated bowel sounds. Noted passing of flatus, bowel movement. Indicators of return of peristalsis, readiness to begin oral intake (Doenges, et al. , 2006). * Provide clear liquids in small amounts when oral intake is resumed, and progress diet is tolerated. Reduces risk of gastric irritation/vomiting to minimize fluid loss (Doenges, et al. 2006). * Stressed the importance of having him on a NPO status and provided the necessary information with regards to his condition and the medications being administered (e. g. , IVF). It provides the patient a full understanding with regards to his condition thus encouraging him to participate and work hand in hand with the staff (Gulanick, et al. , 1994). * Gave frequent mouth care with special attention to protection of the lips. Dehydration results in drying and painful cracking of the lips and mouth (Doenges, et al. , 2006). Dependent: * Maintaine d gastric suction as indicated.Although not frequently needed, an NG tube may be inserted preoperatively and maintained in immediate postoperatively phase to decompress the bowel, promote intestinal rest, and prevent vomiting (Doenges, et al. , 2006). * Administered IV fluids (D5LR 1L x 8 ° or 30 gtts/min) and electrolytes (D5 Balanced Multiple Maintenance Solution w/ 5% dextrose 1L x 8 ° or 30 gtts/min). The peritoneum reacts to irritation/infection by producing large amounts of intestinal fluid, possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances (Doenges, et al. , 2006). * EvaluationShort Term: Goal met. After 30 minutes of nursing intervention the patient was able to have a full understanding with regards to maintaining fluid balance as evidenced by verbalizing, â€Å"So kaya pala hindi pa ako pwede kumain ngaun para maiwasan mairritate ang tiyan ko. † Long Term: Goal met. After 3 days of nursing intervention th e patient was able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor (1-2 seconds), stable vital signs (please see page __ ), and adequate urine output of 620 mL with an appearance of amber yellow. Problem #4: RISK FOR INFECTION – July 24, 2012 Subjective Cues: â€Å"Nurse, sobrang kailangan ba talaga ang paghuhugas ng kamay bago linisan o hawakan sugat niya? †, asked by the mother. * Objective Cues: * Post-operative condition – presence of surgical incision * Surgical site is warm to touch and reddened * Temp: 36. 3 °C * Nursing Diagnosis Risk for infection related to inadequate primary defenses secondary to post-operative surgical incision It is risk to be invaded by pathogens especially if surgical site is near at the perineal area, pathogens can also develop by poor personal hygiene and poor wound cleaning (Doenges, et al. 2006). * Goal/NOC: Risk Control (For Infection) Outcomes Short Term: After 30 minutes of nursi ng intervention the patient will be able to have partial understanding about infection control and will verbalize understanding of and willingness to follow up prescribed regimen. Long Term: After 3 days of  nursing intervention  the  patient will be free of sign and symptom r/t infection. * NIC: Incision Site Care; Infection Control; Wound Care Independent: * Monitored vital signs. Noted onset of fever, chills, diaphoresis, changes in mentation, and reports of increasing abdominal pain.Suggestive of presence of infection/developing sepsis, abscess, peritonitis (Doenges, et al. , 2006). * Inspected incision and dressings. Noted characteristics of drainage from wound/drains, presence of erythema. Provides for early detection of developing infectious process, and/or monitors resolution of preexisting peritonitis (Doenges, et al. , 2006). * Instructed proper hand washing. Practiced aseptic wound care. Reduces risk for infection (Doenges, et al. , 2006). * Encouraged adequate nutr itional intake after the NPO status of the patient and when the patient is allowed to eat.Adequate intake of protein, Vitamin C and minerals is essential to promote tissue and wound healing (Sparks and Taylor, 2005). Dependent: * Administered antibiotics (CEFUROXIME 750mg TID Q 8 ° x 2 doses & METRONIDAZOLE 500g/IV Q 8 ° x 2 doses) as ordered. Therapeutic antibiotics are given if the appendix is ruptured or abscessed or peritonitis has developed (Doenges, et al. , 2006). * Prepare for/assist with incision and drainage (I&D) if indicated. May be necessary to drain contents of localized abscess (Doenges, et al. , 2006). * Evaluation Short Term:Goal met. After 30 minutes of nursing intervention the patient was able to have an understanding about infection control as evidenced by verbalizing, â€Å"Para maiwasan ang pagkaroon ng impeksyon kailangan kong maghugas ng kamay palagi at kinakailangan din ang araw-araw na paglilinis ng sugat ko kahit na sa tuwing nililinisan ito makirot s a pakiramdam. † Long Term: Goal met. After 3 days of  nursing intervention  the  patient was free of sign and symptom r/t infection. Problem #5: INABILITY TO PERFORM ACTIVITY/IES OF DAILY LIVING (ADL) – JULY 24, 2012 * Subjective Cues: â€Å"Hirap talaga ako gumalaw, maglakadlakad, o kahit man lang umupo dahil sa mga nakakabit na ito sa akin,† as verbalized by the patient. â€Å"Nakakapanghina pa kasi masakit nga yung tahi tapos madalas din nagcacramps ang tiyan ko,† he added. * Objective Cues: * Presence of surgical incision * Presence of contraptions (urinary catheter, NGT lavage & IV fluid @ left hand) * Nursing Diagnosis Impaired physical mobility related to body weakness, presence of surgical incision, pain, & presence of contraptions attached Physical immobility can be usually associated with post-operative conditions (Gulanick, et al. 1994). * Goal/NOC: Activity Tolerance Outcomes Short Term: After 30-45 minutes of nursing intervention the pat ient will be able to have a clear understanding with the use of identified techniques to enhance activity tolerance and to apply it as well as evidenced by participating in ROM exercises, lower leg & ankle exercise, ambulation, or even moving up in bed. Long Term: After 2-3 days of nursing intervention the patient will be able to continually participate in a simple form of activity and will report an improvement with regards to his activities. * NIC: Exercise Therapy: BalanceIndependent: * Performed passive ROM exercises. ROM exercises and good body mechanics strengthen abdominal muscles and flexors of spine (Gulanick, et al. , 1994). * Encouraged lower leg and ankle exercises. Evaluated for edema, erythema of lower extremities, and calf pain or tenderness. These exercises stimulate venous return, decrease venous stasis, and reduce risk of thrombus formation (Gulanick, et al. , 1994). * Noted emotional and behavioral responses to immobility. Provided diversional activities. Forced i mmobility may heighten restlessness and irritability.The Cardiovascular SystemDiversional activity aids in refocusing attention and enhances coping with actual and perceived limitations (Gulanick, et al. , 1994). * Assisted with activity, progressive ambulation, and therapeutic exercises. Activity depends on individual situation. It should begin as early as possible and usually progresses slowly, based on client tolerance (Gulanick, et al. , 1994). * Assisted in moving from side to side or up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. Gulanick, et al. , 1994). * Noted client reports of weakness, fatigue, pain and difficulty accomplishing tasks. Symptoms may be result of/or contribute to intolerance of activity (Gulanick, et al. , 1994). Dependent: * Administered pain medication (TRAMADOL 50 mg/IV Q 8 ° x 3 doses, time given: 8 AM) as prescribed and on a regular sch edule. Client’s anticipation of pain can increase muscle tension. Medications can help relax the client, enhance comfort, and improve motivation to increase activity (Gulanick, et al. , 1994). * Evaluation Short Term:Goal partially met. After 30-45 minutes of nursing intervention the patient was able to have a clear understanding with the use of identified techniques to enhance activity tolerance and was able to use all of the techniques except for the ambulation. He refused to walk because he complained of pain whenever the catheter tube slipped into his legs. Long Term: Goal partially met. After 2-3 days of nursing intervention the patient was able to continually participate in all of the identified techniques but still refused to participate in ambulation.He also reported of an improvement with regards to his activities as evidence by his verbalization, â€Å"Medyo natotolerate ko na rin yung mga activities kahit pautay-utay muna. Hindi ko lang talaga muna kaya maglakad p ero pagnaalis na siguro yung catheter baka kayanin ko na. † XV. BIBLIOGRAPHY * Cosgrove DO, Meire HB, Lim A, & Eckersley RJ. (2008). Grainger & Allisonn's Diagnostic Radiology: A Textbook of Medical Imaging (5th edition). New York, NY: Churchill Livingstone * Doenges M. , Moorhouse, M. ; Murr, A. (2006).Nursing Care Plans Guidelines for Individualizing Client Care across the Life Span (7th Edition). F. A. Davis Company, Philadelphia * Doenges, M. , Moorhouse, M. ; Murr, A. (2006). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th Edition). F. A. Davis Company, Philadelphia * Gabriely I, Leu, J. P. , Barky, N. (2008). Clinical problem-solving, back to basics. New England Journal of Medicine * Gould, B. ; Dyer, R. (2011). Pathophysiology for the Health Professions (4th Edition). Saunders Elsevier Inc. * Gulanick, M. Klopp, A. , Galanes, S. , Gradishar, D. ; Puzas, M. (1994). Nursing Care Plans Nursing Diagnosis and Intervention (3rd Edition). Mosby-Year Book, Inc. * LeMone P. ; Burke, K. (2007). Principles of Medical-Surgical Nursing: Critical Thinking in Client Care (4th Edition). Pearson International Edition * LeMone P. ; Burke, K. (2008). Principles of Medical-Surgical Nursing: Critical Thinking in Client Care (5th Edition). Pearson International Edition * Mosby’s Pocket Dictionary of Medicine, Nursing ; Allied Heath (4th Edition) 2002, Mosby Inc. Palma G. ; Oseda A. (2009). G;A Notes Clinical Pocket Guide for Medical and Allied Health Professionals (2nd edition). G;A Notes Publishing Co. , Philippines * Sabol, V. K. ; Carlson, K. K. (2007). Diarrhea: Applying research to bedside practice. AACN Advanced Critical Care * Tortora G. ; Derrickson B. (2006). Principles of Anatomy and Physiology 11th edition. Biological Sciences Textbooks, Inc. * Weber J. ; Kelley J. (2007). Health Assessment in Nursing (3rd Edition). Lippincott Williams ; Wilkins

Thursday, August 29, 2019

American Independent Cinema: Representational Analysis of Women

â€Å"The Hollywood film industry itself has been (and continues to be to a large extent) male-dominated. Hence, male directors, producers, writers, and cinematographers all use the camera as an instrument to look at women. † (Benshoff, pg. 235) Gender also plays a large responsibility in the film industry when pertaining to what females can and can not do in films. Male characters are usually main characters and â€Å"in charge† within films, whereas the female characters are usually limited to just looking pretty while still remaining passive and somewhat outside of all the action within the story. Women today feel a large amount of pressure to look and behave like these female actresses portrayed on the big screen. With the preparation of these films women usually take a very long time in hair and make-up for the sole purpose of looking attractive and gaining more male attention in the films. Many females fail to realize how much time and preparation really goes into the looks and costume designs of the characters that are being portrayed within the film industry. In today’s society female’s feel as though they have to be beautiful and live up to a certain stereotype and â€Å"look† that is extremely unrealistic. Related essay: Pestle Analysis for Odeon Cinema Real Women Have Curves (2002)† was a film directed by Patricia Cardoso that challenges the representation of all women in society. Although the film is about a first generation Mexican-American female struggling with her family’s beliefs, her future, culture, and body, it reaches all female viewers with the same powerful message. The message is that all females can be empowered and should be proud of who they are and where they come from. Most importantly females should be proud of their bodies and not try to live up to the unlikely images that our American culture has welded for us today. Another film and director that challenged the male dominated movie industry was Susan Seidelman with her 1985 low-budget ($5million) film â€Å"Desperately Seeking Susan. † â€Å"†¦Seidelman doesn’t glamorize women at the expense of men. In fact, her strongest affinity is with desperate, aggressive women who never stop hustling. † (Levy, pg. 356) Her film â€Å"Desperately Seeking Susan† looks at contemporary issues of fame, self fulfillment, and social relationships, as well as personal identity. The film is about a petite New Jersey housewife named Roberta, who is bored, unsatisfied, and tired of her marriage routine life at home. She then begins to read the personals section of the New York newspaper for vicarious thrills and entertainment. Her favorite classified to read is one that features the romance of Jim who is a struggling musician and Susan who is a free-spirited single woman living her life in Soho New York. Susan had just recently escaped her ex boyfriend who was a mobster and stole a pair of very expensive Egyptian earrings. One bored day when Roberta reads the classified section she sees the ad â€Å"Desperately Seeking Susan† and decides to follow Susan and Jim. The reasoning as to why Roberta decided to take this extreme measure is because this was a way for her to escape her daily average life and become someone else for a day. The film then takes an unexpected turn and becomes all about reinvention as the housewife Roberta unknowingly with amnesia transforms herself into the wild and care-free character of Susan. There were a number of different codes within the film â€Å"Desperately Seeking Susan (1985)† that made it easier to understand its viewpoint. Some of the cultural codes recognized within the film include cultural, narrative, artistic, cinematic, and intertexual. The film took place during the 1980’s in a small suburban town in New Jersey as well as New York City. The characters of Roberta and Gary Glass are individuals being represented as members of an upper middle class society living in New Jersey. We know that they are upper middle class because of the context clues and dialogue that we see within the movie. We hear Mr. Glass tell his wife â€Å"what are we poor? † when he tells her that she bought a used jacket that used to belong to Jimi Hendrix. Roberta is a bored, full-time housewife and he is a hardworking husband. As the film continues we meet the other main character who is a fun loving, care-free, gold digging, woman named Susan from New York. The film is told through the eyes of the main character, which is a repressed and bored housewife named Roberta. The story is also partially told through the eyes of Susan the carefree and stylish woman from New York. The story is also told through the eyes of Roberta’s worried husband Gary and her love interest Dez. The film â€Å"Desperately Seeking Susan† was very creative and original. Some of the artistic codes within the film include the music in which is exceedingly upbeat and perfect for the time period of the 80’s. The clothing design within the film is extremely important and relevant to the development of Robert’s character. â€Å"Susan’s individualized pyramid jacket signifies her unconventional personal style and her fluency in innovating her own look. The jacket binds the two women together. Susan’s trading of looks shows her competence in putting together an always evolving and eccentric look, while Roberta’s purchase of the (second hand) jacket is part of her adventure and escape. † (Street, pg. 1) The costumes in the film stated the socio-economic status of the main characters and the time period. At the beginning of the film we acknowledge Roberta well dressed with a suburban flare and we also noticed Susan dressed as a stylish, upbeat, rocker. (Complete Opposites! ) The genre of the film â€Å"Desperately Seeking Susan† was comedy, drama, and romance because of its portrayal. The film portrays comedic humor with the mistaken identity of two polar opposites Roberta and Susan. Their journey is a comedic mystery and we never know what will happen next as Roberta searches for adventure and Susan hunts for the stolen Egyptian earring. The film also depicts drama with all of the confusion and an intense romance between Roberta and Jim. In conclusion, the film industry is particularly male dominated. However, there are more female directors, producers, etc. like Susan Seidelman and Patricia Cardoso who are making a remarkable change. These females are making films with predominately female casts, and with messages of strength, personal identity, social relationships and self- fulfillment. They’re challenging the film business and changing perceptions of women everywhere.

Wednesday, August 28, 2019

Homework Essay Example | Topics and Well Written Essays - 500 words - 9

Homework - Essay Example The western wing on the other hand contains the stairwell and smoke tower. The base of the building has intertwined truss system that helps in enhancing the stability of the entire structure in case of any earthquake. The building also has an X-bracing on the top, which assists in resisting torsion movement about the vertical axis of the building (Irvine). The construction process of the Transamerica Pyramid involved the use of various materials deemed as of great quality. Before lying of the first material, the point where the building stands was excavated to a depth of 52 feet. The bottom of the building has complicated system of steel rod reinforcements exceeding 300 miles thickness. About 16000 cubic yards of solid concrete covers the system of the reinforced steel rods. The entire base concrete of the Transamerica Pyramid is in such a way that the entire building moves in case of earthquake. The movement helps in distributing the shockwaves thus reducing damages (EMPROIS). The external parts of the Transamerica Pyramid are fixed with aggregates of quartz that form panels. There are also some rods designed to reinforce the panels at four points on every floor. There is also systematic spacing of the panels that helps in ensuring lateral movement of the building in case of earthquake or tremor. The panels comprises of aluminum louvered structures. The louvered aluminum panels projects to the top to form a 64 meters high spire (EMPROIS). The 48th floor of the building has conference room that provides 360-degree aerial view of the city. The entire external part of the building is white in color. I am always attracted to Transamerica Pyramid because of numerous features the building exhibits. First, I have found it fantastic to explore how the fifth floor of the building happen to be the largest floor and not the first or the second. Logically thinking and considering the shape of the building, the largest floor ought to

Tuesday, August 27, 2019

Human Resource Management Study Report on Grimshaw's Quality Textiles Essay

Human Resource Management Study Report on Grimshaw's Quality Textiles - Essay Example Despite problems in the industry QualTex is surviving. It makes clothes for well-known supermarket chains, and given the explosion of this part of the market, is managing to turn a respectable profit 2. The company has a reasonable reputation as a local employer, the rates of pay are good for the area, and it has an unproblematic industrial relations record (at least there haven't been any strikes in the last ten years). However, it does have a high labour turnover, there have been some worrying health and safety issues and a couple of serious accidents at the factory in recent months. It also has a reputation as an 'old-fashioned' place to work. All issues to do with personnel and industrial relations have been managed by the Managing Director and his PA. The PA keeps the personal records of all employees and the MD has published a number of Personnel Policies to cover 'Absence', 'Discipline' and 'Regulations on wearing Personal Protective Clothing at work'. The MD expects the section managers to 'manage' the people issues in the factory 3. What are completely missing are any training, learning and development activity other than the minimum of health and safety training, and some cursory induction training on appointment. Focused Point # II: The workforce of the factory has recently been stunned by the news, which was announced by the Managing Director on 1 December last year. The announcement was as follows: 'In order to ensure the survival of QualTex in these difficult times for the textile industry, the company will merge with Grimshaw 's Fabric Company with effect from 1 January 2007. This is not a take over, but must be seen as a new partnership of long-standing successful Lancashire Textile manufacturers. The merged company will be registered at Company's House under the new name of 'Grimshaw's Quality Textiles'. This is a startling development. Grimshaw's is a highly successful textile manufacturer, which has modernised its plant and streamlined its production at its factory in Accrington. Unit costs are kept to a minimum, employees are paid minimum wage rates, but are part of a profit-sharing scheme and get good payouts at two crucial points in the year, immediately before the summer shutdown for 'Accrington holidays' and again before Christmas. Health and Safety records appear to be good, with a reduction of 'incidents' since 2004. There have been some difficulties with industrial relations and there was recently a walkout by employees protesting about the low level of pay 4. Focused Point # III: The threat of losing last year's Christmas profit share bonus brought everyone back to work very quickly. The management of Grimshaw's has a reputation for being tough. "If your face doesn't fit...you 're out' is a frequent complaint amongst Grimshaw's employees. Grimshaw's employs a Personnel Manager who is responsible for the issue and implementation of personnel policies and

The Growth of World Exports Research Paper Example | Topics and Well Written Essays - 2500 words - 3

The Growth of World Exports - Research Paper Example Third, the strong regional developments have been accompanied by strong growths in merchant dice trade as Table 1 would show.   The strong economy of emerging countries is accompanied by strong exports and imports. Fourth, export growth the receives continued support from the world economy. As Table 1     below shows, the combined merchandise exports of major economies integrate into the strong export growth of the world of 6.5% in 2005, 8.5% in 2006 followed by a decline of 5.5% in 2007.   In   2007, the effect of the recession is starting to appear as trading slows down in most of the countries, with exception of the emerging economies that displayed its strength beyond the crisis. We have seen China, Asia and India emerged as strong exporters.  Tariff and quotas are both methods of controlling imports but the tariff is preferred over the other because of its advantages. Tariff is a tax placed on imported or exported goods while quota is a government imposed limit on th e importation of goods. Tariff is a source of revenue for the government and frequently imposed to protect domestic producers from foreign competition (Boyes & Melvin, 2000.p. 494).   For instance, a country that does not produce cars may place a tariff on imported cars. The quantity imported will be controlled because of the increase in price and the lessened demand for the cars because of the price.   The tariff has an effect of reducing importation.  The quota is another government tool that puts a limit to the quantity or value of goods and services imported and exported. A quota may be imposed through quantity quota or a value quota.   In a quantity quota, the physical amount of good is restricted. For example, the United States has a U.S. quota for its sugar importation that is set yearly that depends on their domestic needs. For 2010, U.S. quota based on quantity is 1.471 million of sugar (Bjerga, 2010). Another kind of restriction related to quota is valuing quota th at restricts the money value of the product, so instead of physical quota, the U.S. could limit the dollar value of sugar imported (Boyles & Williams, 494)

Monday, August 26, 2019

Native America and Hispanic Cultures in Michigan Research Paper

Native America and Hispanic Cultures in Michigan - Research Paper Example (US Bureau of Census 2008) I will address these two cultures separately in this paper but that both would be examined through the same parameters as demonstrated by the concept maps previously drafted. The parameter worked around three issues. These are education, family traditions and political background. I believe that these factors collectively characterize the wider cultural characteristics of the subject cultures. In regard to education, it varies through time and across cultures and so, it is necessary in establishing the cultural background of an ethnic group. Family traditions, meanwhile, reflect the way of life of the ethnic groups and, hence, demonstrate their culture. Finally, the political background was included in order to determine the minorities’ views on social issues in the context of their way of lives. These three variables characterize the cultural dimensions required in order for me to achieve my objectives. The methods employed for the research of sources used is a mix of first-hand interview, first-hand sources from government publications and research of second-hand sources from available literature such as books, journal and magazine. In regard to internet sources, the keywords used in the research include â€Å"Michigan demographics,† â€Å"Michigan Native Americans,† â€Å"Michigan education statistics,† and â€Å"Michigan voters profile.† The main search engine used was Google. I think the most important sources would be the government data from the US Bureau of Census as they represent the holistic status of the both the ethnic groups demography and cultural background. Because of this, it became easier to compare specific characteristics. The first-hand sources and interviews are also important because they allowed me to confirm and experience the major findings of the research. Because of this I was able to synthesize all the information that I was able to collect from all the relevant literature

Sunday, August 25, 2019

Project Management Paper Research Example | Topics and Well Written Essays - 1250 words

Project Management - Research Paper Example The project needs progressive elaboration that reveals and focuses details of the project through time (Meredith & Mantel, 2012). This makes projects distinguished from programs and operations. A program is a group of interrelated projects coordinated to obtain benefits and control that cannot be achieved when managing the projects individually. Operations are continued and repetitive activities that are carried to achieve mission of the organization without a definable end or unique output. Project management is a planned and organized one-time activity that achieves the specified goals. Developing project plan that covers defining project objectives and goals, specifying tasks, stating how goals will be achieved, the resources needed, budget, timelines for implementing and completing the project will ensure success of a project as planned. The following are the basic five phases in the project life cycle (Project, 2013). This is the opening or starting point of the project. The project is initiated by defining the reasons, the objectives and scope of it. The project team at this level proposes the solutions to be implemented, and the early budget. This gives a go for a project. The draft of the scope and objectives will help the team to work on the course without deviating. The draft schedule will also provide the timeline through wish the project is expected to be completed. This also helps the project team to get organized. Terms of references are also incorporated so that the team can know how and to whom referencing is made. This phase leads to another step. After the initiation phase and creating of drafts, the project management plan is designed. The plan will guide the team during project development and after. This step defines the required skills that will be in development team. It also describes the risk pal, non-labor resources, detailed action items and milestones. The is a need to

Saturday, August 24, 2019

Cross Cultural Literature Essay Example | Topics and Well Written Essays - 2000 words

Cross Cultural Literature - Essay Example It is also a way to change perception regarding one’s culture and instead of stereotyping, people should learn the beliefs of others. While going global, the diversification is much more and one gets a chance to deal with different type of dealing with various types of people who are different from them in terms of culture, religion, habits and much more. At that time it is important for one to know the aspects of dealing with the diversification. Cross Cultural literature is important because of the consistent changing of trends from West to East. Communication Challenges in Cross Culture Communication is a great challenge while moving into the different cultures because if one act is followed in one culture then it’s not necessary that the same act will also be supported in other cultures. While going global or Glocal in business, the management should have the international understanding of the cultures so that it gets easier for them to communicate with different cl asses of people. There are certain cultural variables that need to be studied while communicating with different people; Attitudes It means stereotyping. Usually people when they move from one country to another for work purpose, these types of problems arise. Managers or employees working in that environment start over generalizing those who are different from their cultures. ... Role Role means the status and level of one based on his age. Usually every individual is treated equally but within these rules people try to discriminate their companions or subordinate. Language Language is a bridge between various cultures. It create the big difference because while communication there are different meanings of different statements. Example: â€Å"COME OUT OF THE GRAVE WITH PEPSI† This statement is considered right in context of west culture but when it comes to regions or cultures like India, this statement is proved to be wrong. For India where majority is the follower of Hinduism, this statement is not effective because it’s hitting their cultural values. So while sharing any idea regarding something, one should be alert or aware of the words he/she is using to give the idea because it may or may not directly pointing their culture but indirectly it could be taken in wrong meanings. One more example is â€Å"When YES doesn’t mean YES†. It means that when Chinese, Japanese and Pakistanis say YES while talking to someone, that doesn’t means that they will follow your commands, it actually means that â€Å"YES we are listening to you†. Non-Verbal Communication Non-Verbal Communication plays a very important role in context of cultural diversification. It includes kinesics behavior (E.g., Sticking out the tongue in China); Power distances (Proximity- E.g. The corner office, Closeness when talking), Paralanguage (e.g. the sound of silence), Objective Language (E.g. Monochronic vs. Polychronic) and most importantly eye contact. Trust in conducting Business within cross cultures There are some countries that do negotiate

Friday, August 23, 2019

Individuals who suffer from depression are more likely to use drugs Essay

Individuals who suffer from depression are more likely to use drugs - Essay Example Even though there is nothing that could prevent un-depressed people trying to hit a high with the use of drugs, according to the research work available and psychological treatment records on drug abuses and depression, it is the depressed lot who turn frequently towards drugs, although the drug-induced depression too could be equally true. Drug depression could be worse in people who are genetically susceptible to depression and hence, there is a strong connection between them. Curtis (2001) says that depression should be treated without even psychotropic drugs like Prozac and the depressed people should be able to 'pull the plug' on depression with 'directed thinking'. David Healey (2004) called the relationship between pharmaceutical antidepressants and depressed individuals, extremely unhealthy. When medicinal drugs are advised to be abhorred, it stands to reason that hallucinating drugs cannot make positive contributions. Still the fact remains that according to existing research and statistics available in the field of psychology, depressed people reach for drugs as the most hopeful means of controlling depression and feeling ecstatic driven by anxiety, loneliness and depression. Drug addiction can store metabolite in the body with further side effects. Depression and drugs can encourage one another and work together towards a horrible mental and physical end. This does not mean that non-depressed do not take drugs. Their number is negligible compared to the depressed, their percentage is negligible. An astonishing majority justifies my hypothesis and hence, I would like to conduct my study on this hypothesis with the support of researched evidence, articles, journals, books, reports, statistical data etc.

Thursday, August 22, 2019

The theatrical drama Essay Example for Free

The theatrical drama Essay Eddies life is very good to him at the start of the play and his ideas of manliness never really come under threat. That is until Marco and Rodolpho arrive. Marco and Rodolpho are Beatrices nephews and have illegally emigrated from Italy. Marco and Rodolpho are at the two furthest points away from each other on Eddies manliness scale. Marco is very manly, more so than Eddie. He is very strong, very quiet and cares more about the necessities of living than having a good time. Rodolpho on the other hand does not conform to Eddies views of manliness at all and this creates minor conflicts on a regular basis, but Eddie really begins so dislike Rodolpho when he starts to have a relationship with Catherine. Eddie begins to tell everybody that Rodolpho aint right and is no good. He accuses Rodolpho of being effeminate and suspects that his blond hair isnt natural and says that his singing makes him sound like a chorus girl. Eddie makes these links because he is intellectually limited and acts by instinct and prejudice. Eddies lack of intelligence eventually leads to him actually believing all of the things hes made up about Rodolpho. This leads to conflicts, as he feels threatened when he tries to justify his accusations and ends up being quite comical. An example of this is when he goes to see Mr Alfieri (his lawyer). Eddie is asking Mr Alfieri what he can do to stop Rodolpho marrying Catherine. Mr Alfieri is telling Eddie that he cant do anything and he can only deal in whats provable and the only thing thats provable is that hes an immigrant. Eddie then begins to get annoyed and tells Mr Alfieri that The guy aint right and hes a blond guy. Like platinum But Mr Alfieri cannot understand what Eddie is trying to say. This is because Eddie really doesnt know whats hes saying, hes just making it up as he goes along. This is highlighted by the constant pauses when he is speaking. Eddies constant stuttering as he tries to make Mr Alfieri understand what he is trying to say, shows the audience that he is lying/making it up. Eddies dislike of Rodolpho bubbles under the surface throughout Act One and in Act Two Eddie and Rodolpho have a conflict, which is a pivotal moment in the structure of the play. Eddie comes home drunk to find that Catherine and Rodolfo have been in the bedroom together. He immediately thinks the worst and tells Rodolfo to get out of his house. Catherine argues with him and then decides that she has to leave as well but Eddie grabs her. Rodolfo reacts angrily to this and flies at Eddie in attack. To this Eddie pins him to the floor and unexpectedly kisses him. Eddie gets up with tears rolling down his face and laughs, mocking Rodolpho. This is a big moment as it is the first time Eddie has acted to back up his displeasure of the way Rodolfo has acted but it evidently hasnt helped his cause of getting Catherine to split up with him and has in fact caused more of a friction between himself and Catherine. It is also the first time that Eddie has shown very non masculine behaviour, by firstly kissing Rodolpho on the lips which completely contradicts Eddies accusations of Rodolpho being a homosexual and shows Eddie as being a hypocrite and secondly by crying, although both of these things could be blamed on Eddies drunken state. It is usually when someone is drunk that they forget to carry on their charade and reveal who they really are.

Wednesday, August 21, 2019

How We Can Make the World a Better Place Essay Example for Free

How We Can Make the World a Better Place Essay Every day, and I mean every day, the world slowly gets a better chance of surviving an epidemic. But every day, the world slightly perishes and begins to crumble. And I don’t mean literally crumble. Maybe just a little. But anyways the world starts becoming a bad place to live in. Whether it’s from pollution or foreign matter. But I will be talking about pollution mostly. People pollute every second of the day. I’m serious. And the bad thing is that there may not be a way to stop these people from polluting. Governments and agencies have tried numerous times to encourage people to stop even if it’s slowly at a time. And now they try to help by coming out with electric cars and allow recycling more often. Yet is it enough? It may be but then again it’s most likely not. You see, the sun lets light in so we can see and have nutrients. And there is the little thing called the ozone layer that keeps a little of the sun in but not a lot of it. With the ozone layer, the heat and light from the sun bounces back towards itself. Like I said, the ozone layer only allows a little of the sun in. yet, by pollution the ozone layer becomes thinner and thinner allowing more sun to come in and fry us. I’ll break it down for you. Lets take smoke from refineries or a car. The smoke goes in to the air and mixes with the clouds. But some of that smokes breaks through and collides with the ozone layer causing erosion which makes the ozone layer thinner, allowing more sun in. Pollution is bad! But that’s not the only kind of pollution. Lets talk about out lovely streets and plants. Although its hard to call them lovely. Take an ordinary beautiful garden maintained by caring people. Example: Bob waters his garden and clears it of weeds regularly. Everyone who walks by tells Bob that his garden is beautiful with a capital B. yet what Bob and all the others don’t know is that under that beautiful garden lies deadly fumes that slowly kill the flowers. A year later, Bob finds his garden unexpectedly dying. What Bob also doesn’t know is that the house that was built on his wonderful grass has eroded over the past few years allowing the deadly material of the house to seep underground and spread throughout the yard. Therefore, killing his beautiful garden. The End. Or is it? Every day we pass by trash on the streets and don’t bother to pick it up. Some don’t because they are lazy and some others don’t because they are embarrassed. Id sometimes be counted as the one with embarrassment. But not always. Anyways, what I’m proposing is that instead of ignoring all those boring environmental commercials on  television, we should actually listen to them and join hands to erase all the pollution. After that problem is wiped out, we’d have a better place to live in and live a longer, healthier life. But first if we must start little, then it’s best if we start with the trash we see on our own streets. Recycle more often too. It really helps get waste off the street. Join community service programs and aim for captain of the litter removal club. Just talk to your counselor or environmental adviser. In my own opinion, I know you will be the best. Thank you.

Tuesday, August 20, 2019

Rate Of Convergence In Numerical Analysis

Rate Of Convergence In Numerical Analysis In numerical analysis, the speed at which a convergent sequence approaches its limit is called the rate of convergence. Strictly speaking, a limit does not give information about any finite first part of the sequence; this concept is of practical importance if we deal with a sequence of successive approximations for a iterative method, as typically fewer iterations are needed to output a useful approximation if the rate of convergence is higher. This may even make the difference between needing ten or a million iterations. Similar concepts are used for discretization methods. The solution of the discretized problem converges to the solution of the continuous problem as the grid size goes to zero, and the speed of convergence is one of the factors of the efficiency of the method. However, the terminology in this case is different from the terminology for iterative methods. Convergence speed for iterative methods Basic definition Suppose that the sequence {xk} converges to the number L. We say that this sequence converges linearly to L, if there exists a number ÃŽÂ ¼ à ¢Ã‹â€ Ã‹â€  (0, 1) such that The number ÃŽÂ ¼ is called the rate of convergence. If the above holds with ÃŽÂ ¼ = 0, then the sequence is said to converge superlinearly. One says that the sequence converges sublinearly if it converges, but ÃŽÂ ¼=1. The next definition is used to distinguish superlinear rates of convergence. We say that the sequence converges with order q for q > 1 to L if In particular, convergence with order 2 is called quadratic convergence, and convergence with order 3 is called cubic convergence. This is sometimes called Q-linear convergence, Q-quadratic convergence, etc., to distinguish it from the definition below. The Q stands for quotient, because the definition uses the quotient between two successive terms. Extended definition The drawback of the above definitions is that these do not catch some sequences which still converge reasonably fast, but whose speed is variable, such as the sequence {bk} below. Therefore, the definition of rate of convergence is sometimes extended as follows. Under the new definition, the sequence {xk} converges with at least order q if there exists a sequence {ÃŽÂ µk} such that and the sequence {ÃŽÂ µk} converges to zero with order q according to the above simple definition. To distinguish it from that definition, this is sometimes called R-linear convergence, R-quadratic convergence, etc. Examples Consider the following sequences: The sequence {ak} converges linearly to 0 with rate 1/2. More generally, the sequence CÃŽÂ ¼k converges linearly with rate ÃŽÂ ¼ if |ÃŽÂ ¼| CONVERGENCE SPEED FOR DISCRETIZATION METHODS A similar situation exists for discretization methods. Here, the important parameter is not the iteration number k but the number of grid points, here denoted n. In the simplest situation (a uniform one-dimensional grid), the number of grid points is inversely proportional to the grid spacing. In this case, a sequence xn is said to converge to L with order p if there exists a constant C such that | xn à ¢Ã‹â€ Ã¢â‚¬â„¢ L | This is written as |xn L| = O(n-p) using the big O notation. This is the relevant definition when discussing methods for numerical quadrature or the solution of ordinary differential equations. Examples The sequence {dk} with dk = 1 / (k+1) was introduced above. This sequence converges with order 1 according to the convention for discretization methods. The sequence {ak} with ak = 2-k, which was also introduced above, converges with order p for every number p. It is said to converge exponentially using the convention for discretization methods. However, it only converges linearly (that is, with order 1) using the convention for iterative methods. RATE OF CONVERGENCE OF BISECTION METHOD If f is a continuous function on the interval [a, b] and f(a)f(b) The bisection method gives only a range where the root exists, rather than a single estimate for the roots location. Without using any other information, the best estimate for the location of the root is the midpoint of the smallest bracket found. In that case, the absolute error after n steps is at most If either endpoint of the interval is used, then the maximum absolute error is the entire length of the interval. These formulas can be used to determine in advance the number of iterations that the bisection method would need to converge to a root to within a certain tolerance. For, using the second formula for the error, the number of iterations n has to satisfy to ensure that the error is smaller than the tolerance ÃŽÂ µ. If f has several simple roots in the interval [a,b], then the bisection method will find one of them. RATE OF CONVERGENCE OF FALSE-POSITION METHOD If the initial end-points a0 and b0 are chosen such that f(a0) and f(b0) are of the opposite signs, then one of the end-points will converge to a root of f. The other end-point will remain fixed for all subsequent iterations while the converging endpoint becomes updated. Unlike the bisection method, the width of the bracket does not tend to zero. As a consequence, the linear approximation to f(x), which is used to pick the false position, does not improve in its quality. One example of this phenomenon is the function, f(x) = 23 à ¢Ã‹â€ Ã¢â‚¬â„¢ 42 + 3x on the initial bracket [à ¢Ã‹â€ Ã¢â‚¬â„¢1,1]. The left end, à ¢Ã‹â€ Ã¢â‚¬â„¢1, is never replaced and thus the width of the bracket never falls below 1. Hence, the right endpoint approaches 0 at a linear rate. While it is false to think that the method of false position is a good method, it is equally a mistake to think that it is unsalvageable. The failure mode is easy to detect and easily remedied by next picking a modified false position, such as or down-weighting one of the endpoint values to force the next ck to occur on that side of the function. There are other ways to pick the rescaling which give even better convergence rates. RATE OF CONVERGENCE OF SECANT METHOD The iterates xn of the secant method converge to a root of f, if the initial values x0 and x1 are sufficiently close to the root. The order of convergence is ÃŽÂ ±, where is the golden ratio. In particular, the convergence is superlinear. This result only holds under some technical conditions, namely that f be twice continuously differentiable and the root in question be simple (i.e., with multiplicity 1). If the initial values are not close to the root, then there is no guarantee that the secant method converges. The right-most quantity above may be expressed as since . Then, from a Taylor expansion of about one finds for some . Similarly Placing these quantities into Equation 4.9 will result in some cancellation, or The approximation expressed in Equation 4.11 can be explicitly quantified by recognizing that for some . Hence This completes the analysis of the final term in Equation 4.8. The first term in Equation 4.8 can be analyzed similarly, to obtain Hence, the error given in the secant method is roughly given as A more careful investigation and analysis produces the exact expression for some . To generate a complete convergence analysis, assume that f(x) is bounded and in some neighborhood of . These assumptions imply that sufficiently close to . Further, assume that the initial values and are chosen sufficiently close to to satisfy for some K The exponents on K form the Fibonacci sequence, . The Fibonacci sequence is defined inductively, as The general error term is then given to be The Fibonacci number have an explicit formula, namely with . Note that , and since K At this point, we have While somewhat complex-looking, the equation above actually produces the convergence rate that we seek. RATE OF CONVERGENCE OF NEWTON RAPHSON METHOD Suppose that the function Æ’ has a zero at ÃŽÂ ±, i.e., Æ’(ÃŽÂ ±) = 0. If f is continuously differentiable and its derivative is nonzero at ÃŽÂ ±, then there exists a neighbourhood of ÃŽÂ ± such that for all starting values x0 in that neighbourhood, the sequence {xn} will converge to ÃŽÂ ±. If the function is continuously differentiable and its derivative is not 0 at ÃŽÂ ± and it has a second derivative at ÃŽÂ ± then the convergence is quadratic or faster. If the second derivative is not 0 at ÃŽÂ ± then the convergence is merely quadratic. If the third derivative exists and is bounded in a neighbourhood of ÃŽÂ ±, then: where If the derivative is 0 at ÃŽÂ ±, then the convergence is usually only linear. Specifically, if Æ’ is twice continuously differentiable, Æ’ (ÃŽÂ ±) = 0 and Æ’ (ÃŽÂ ±) à ¢Ã¢â‚¬ °Ã‚   0, then there exists a neighbourhood of ÃŽÂ ± such that for all starting values x0 in that neighbourhood, the sequence of iterates converges linearly, with rate log10 2 (Sà ¼li Mayers, Exercise 1.6). Alternatively if Æ’ (ÃŽÂ ±) = 0 and Æ’ (x) à ¢Ã¢â‚¬ °Ã‚   0 for x à ¢Ã¢â‚¬ °Ã‚   0, x in a neighbHYPERLINK http://en.wikipedia.org/wiki/Topological_neighborhoodourhood U of ÃŽÂ ±, ÃŽÂ ± being a zero of multiplicity r, and if Æ’ à ¢Ã‹â€ Ã‹â€  Cr(U) then there exists a neighbourhood of ÃŽÂ ± such that for all starting values x0 in that neighbourhood, the sequence of iterates converges linearly. However, even linear convergence is not guaranteed in pathological situations. In practice these results are local and the neighbourhood of convergence are not known a priori, but there are also some results on global convergence, for instance, given a right neighbourhood U+ of ÃŽÂ ±, if f is twice differentiable in U+ and if , in U+, then, for each x0 in U+ the sequence xk is monotonically decreasing to ÃŽÂ ±. Proof of quadratic convergence for Newtons iterative method According to TaylorHYPERLINK http://en.wikipedia.org/wiki/Taylors_theoremHYPERLINK http://en.wikipedia.org/wiki/Taylors_theorems theorem, any function f(x) which has a continuous second derivative can be represented by an expansion about a point that is close to a root of f(x).

Objectification in An Elegy Written in a Country Church Yard Essay

Objectification in An Elegy Wrote in a Country Church Yard  Ã‚   In "An Elegy Wrote in a Country Church Yard," Gray symbolizes the objectification of the poor as well as the commodification of nature. In doing this, Gray arranges a hierarchy of objectification within the poem. The hierarchical arrangement begins with nature and continues through the poor with the upper class at the apex of the "pyramid." Gray uses the recurring images of nature to illustrate this organization of classes. To accomplish this arrangement, he shifts the focus from nature to the poor through these images. Finally, in "An Elegy Wrote in a Country Church Yard," death of the poor is the only hope for both nature and the peasants to obtain freedom. In other words, by dying, the poor are no longer objectified by the upper class and nature is no longer objectified by the poor. In his "Elegy," Gray symbolizes the objectification of the poor and nature through a hierarchical arrangement and states that death is the only means by which they can both be free. First, Gray uses images of nature to show the pyramid of power and control in society. Through the imagery of the poem, Gray illustrates the ownership of the land and the poor. They are commodities of the wealthy, land owning members of the upper class. Gray writes "Oft did the Harvest to their Sickle Yield/ Their Furrow oft the stubborn Glebe has broke;/How bowed the Woods beneath their sturdy Stroke!"(lines 25-26, 28). These lines not only symbolize the commodification of nature but also of the lower classes. The image of the woods bowing to the poor shows the control the peasants have over nature. The breaking of the land by the sickle also demonstrates the physical might and domination the poor ... ...image of water. Images of the woods "bowing" to the poor workers and of the oceans carrying the sins of the people illustrate the commodification of nature. Images of the poor "wading through Slaughter" and of them harvesting the fields demonstrate the objectification of the lower class in English society. In doing this, Gray establishes a class system with the upper classes controlling the members of the lower classes. After establishing this system of society, Gray then shifts the focus of the poem from the hierarchy to the emancipation of these commodities. Death is the only means for the poor and the land to be freed from society. Works Cited: Gray, Thomas. "Elegy Written in a Country Churchyard." in Damrosch, David. The Longman Anthology of British Literature: Volume 1C The Restoration and the 18th Century. New York: Addison Wesley Longman, Inc. 1999.