Maxine Kumin Drifted Away at Age 88

Even the most beautiful people have to die; Maxine Kumin, an exceptional U.S. poet, died recently at the age of 88. â€Å"Roberta Frost†, as some of her friends and devotees called her, drifted away peacefully at her farm in Warner, New Hampshire. Its a relief, that her final book â€Å"And Short the Season† will only be published this spring, thus extending her life as a writer. Besides, at the end of her life she wrote a young adult novel â€Å"Lizzie!†, which shall be published in March by Seven Stories Press/Triangle Square. The Beginning of the Story: Youth Maxine Kumins birth took place in Philadelphia in 1925. At first she received a degree of Bachelor of Arts at Radcliffe College and than Kumin continued her education at the Boston Center for Adult Education, where she took a poetry writing course. Maxine Kumin wrote poetry, as she was yet a teenager, and now, as an adult, she was going to follow her dreams. It was the poetry writing course, where she first met Anne Sexton, another famous U.S. poet, who remained her best friend till 1974, when Sexton committed a suicide. And it was the poetry writing course, thanks to which Kumin published her poems in such a magazine as The New Yorker. Later, at the age of 36, Maxine Kumin got to publish her first book, â€Å"Halfway†, where her early poems were collected. The Middle of the Story: Poetry Kumin won many awards, among them are the Ruth Lilly Poetry Prize, as well as the Pulitzer Prize (the latter she got in 1972 for her poetry collection called â€Å"Up Country: Poems of New England†). Among her works you can find not poems alone, but also childrens books, short stories, novels and even a memoir. Nevertheless, Maxine Kumin is considered to be more of a poet than of a writer. When asked of her writing style once, Kumin said: â€Å"People see something and say all the time, ‘Now that’s a poem!’ I never see it that way. That’s not how I get my poems. What I’ve experienced may make its way into my poems, but it’s not what generates a poem. I take what comes. I don’t prepare for a poem. Something seeks me out, and then I check it out, and then I work on it.† The End of the Story: Peace The last year of her life Maxine Kumin spent on her huge farm, which she bought in 1963 in Warner, N.H. She lived there with her husband, breeding sheep and horses. Horses were a special part of her life – Kumin adored these animals and was herself an experienced horsewoman. It just happened so that she was severely hurt at the age of 73 in an accident, while training her horse for a carriage-driving show. She recovered, but a serious damage, which was made to her body back then, did influence her gradual decline in health.

First Aid Study Notes - 1390 Words

First Aid Notes Q. Why is first aid important? A. It is better to know first aid and not need it than to need it and not know it. Q. What is first aid? A. First aid is the immediate care give to an injured or suddenly ill person. Q. What is Duty of Care? A. While providing first aid you have a duty of care which requires you to assess and treat the casualty within the confines of your training and expertise i.e. you must only do what you are trained to do. Q. What is CPR A. CPR stands for CARDIOPULMONARY RESUSCITATION Q. What is Cyanosis A. CYANOSIS is the result of low levels of oxygen in the blood resulting in the skin and mucous membranes becoming blue or grey Key Terms: Consent: You must obtain consent from an alert person before†¦show more content†¦During a Secondary Survey for an injury check Head, Neck, Chest, Abdomen, Pelvis, Extremities Back (if no suspect spinal injury) for DOTS CHECK FOR MEDICAL IDENTIFICATION JEWELLERY/CARDS ETC Also check for SKIN Colour, Temperature and Moisture SKIN COLOUR: Pink = Normal Red Flushed = Excited, exposure to Heat, High Blood Pressure or Carbon Monoxide Poisoning White Pale = Shock, Emotional Distress, Constricted Blood Vessels from blood loss Blue = Cyanotic, Lack of Oxygen in blood and tissues from breathing or heart problems Yellow = Liver Disease or Failure, Jaundice.Show MoreRelatedA Research Study On Financial Aid875 Words   |  4 Pagestheir respective institutions, but were not considered in the study. 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The Immigration Cancer Essay Research Paper The free essay sample

The Immigration Cancer Essay, Research Paper The Immigration Cancer The first move halting in-migration decided by Congress was a jurisprudence in 1862 curtailing American vass to transport Chinese immigrants to the U.S. The Alien Contract Labor Laws of 1885, 1887, 1888, and 1891 restricted the in-migration to the U.S. of people come ining the state to work under contracts made before their reaching. Alien skilled labourers, under these Torahs, were allowed to come in the U. S. to work in new industries. By this clip anti-immigrant felling rose with the inundation of immigrants and in this period the anti-Catholic, anti-foreign political party the Know-Nothings, was already born. The jobs and issues are still much the same today, as they were 150 old ages ago, but as the Numberss and facts show the in-migration job is turning worse and worse. After World War I a pronounced addition in racism and the growing of isolationist sentiment in the U.S. led to demands for farther tightened statute law. In 1921 a congressional act provided for a quota system for immigrants, which the figure of foreigners of any nationality admitted to the U.S. in a twelvemonth could non transcend 3 per centum of the figure of nonnative occupants of that nationality life in the U.S. in 1910. ( Potter, Gerald. , Congressional Quarterly 1921 ) This jurisprudence applied to states of Europe, the Middle East, Africa, Australia, New Zealand, Asian Russia, and certain islands in the Atlantic and Pacific. In the 1980s concern about the rush of illegal foreigners into the U.S. has led Congress to go through statute law aimed at cutting illegal in-migration. The Immigration Reform and Control Act of 1986 allows most illegal foreigners who have resided in the U.S. on a regular basis since January 1, 1982, to use for legal position. Besides, the jurisprudence prohibits employers from engaging illegal foreigners and authorizations punishments for misdemeanors. Argument over in-migration and in-migration policy is non new to the state # 8217 ; s history. From clip to clip, Congress brought statute law to command the flow of in-migration. As in-migration rises and hatred grows more Torahs will be implemented seeking to let go of some of the force per unit area. Illegal in-migration has some pros and cons. Here are some of the alleged pros if they re truly that is problematic. It offers cheaper labour to concerns. By non paying minimal rewards to the workers who are willing to work for a lower monetary value, this gives the concern an border over other rivals. It Provides civilization diverseness in the United States. Bringing in immigrants gives more and different civilizations to the U.S. which can spread out concerns to other Fieldss of the universe. Besides giving people a more apprehension of other civilizations. Lowers the cost of merchandises produced in the U.S. that we buy. If the concerns can bring forth merchandises and services a t a low monetary value maintaining there overhead low, so we as a consumer will besides pay a lower monetary value. Most illegals are skilled workers and helps run the economic system. Other states economic systems are besides being helped. The workers bring money to their households out side of the U.S. which in most instances the U.S. dollar has a higher value than their ain. Most people disagree stating the cons of this issue out manner the pros. Here are some of the cons to this horrid job. Illegal immigrants pay no revenue enhancement. If they pay no revenue enhancements so how can we as a state wage for public services we every bit good as they do. Sending money out of our economic system and directing it to their households abroad. If money is taken out of our economic system it causes a pecuniary job. this can do an inaccurate history of money in circulation, which might do rising prices. Lower rewards ; if an illegal is willing to work for under the lower limit pay so the e mployer will non pay more for the occupation to any other employ. In fact might higher lone illegals and take away occupations form legal occupants who are willing to work. When illegals come to this state they do non acquire tested for diseases that might infect the population. Which can do a wellness job. Such as infantile paralysis, TB and other signifiers of diseases. Illegals cost the provinces money, paying for instruction, wellness attention, and other societal services. In an already under funded plans they give these services a more heavy load to cover with. When it comes to illegal immigrants there are a batch of involvement groups that have been involved in this issue. From concerns to authoritiess bureaus. The concerns, particularly in agribusiness. Agriculture employs more undocumented workers than any other industry in the state. Half of California # 8217 ; s 700,000 farm workers are estimated to be undocumented. # 8220 ; Three decennaries ago, the per centum of nonnative farm workers in California was 50 per centum, # 8221 ; 8 the San Francisco Chronicle stated. # 8220 ; Now it is 92 percent. # 8221 ; ( Opinion, SF Chronicle, July 4th 1998 ) Agribusiness, nevertheless, is non the lone industry with an insatiate demand for the inexpensive labour provided by immigrants. These concern groups have a batch of involvement in illegal in-migration. They provide cheaper labour, which cuts costs and causes better competition. 11 Government bureaus are besides involved. The new in-migration statute law about doubles the size of the Borde r Patrol. In add-on, National Guard and active-duty armed forces forces are used more and more along the boundary line. Our thoughts for work outing the jobs are reasonably straightforward. First, would be implementing a armed wall on the U.S. Mexican boundary line. Pat Buchanan foremost proposed this in the 1992 Presidential elections. The thought of the wall is since economical disincentive and any other plans we ve done over the past 40 old ages since Mexican in-migration has risen has been an absolute failure. Since we re unable to work out the job through peaceable classs of action, it s clip to acquire serious. 92 % of illegal in-migration comes from Mexico with 6 % coming from the Caribbean and the other 2 % from SE Asia and Europe. So the 1st key in decelerating down in-migration would be halting the Mexican s from coming into our state. The wall would wholly close down their attempts to take away the glorious chances American s have. If you shoot them as they come over effort to come over. What would be the benefit for them? They couldn t perchance do it and after a few got shot the message w ould be clear that American s Dons t want us here and if we try we re traveling to pay the monetary value. The other stairss to maintaining them in their ain state would be to better the economic conditions within their ain state. The thought would be to cut off foreign assistance, alternatively of trusting on American and international press releases they could get down to develop something they ve yet to hold the enterprise to get down. Industry A ; Hard work! Immigration has taken a great toll on the United States the immigrant population is turning faster so the native born population and it s about clip we do something about it and take back our state non theirs. Certain it s true that we were all immigrants at one clip but merely as the fundamental law alterations America has changed every bit good. We re no longer the Great Melting Pot we re our ain separate civilization and that civilization has no more room for illegal immigrants and really minimum room for new immigrants. The thought of shuting the boundary lines up is non a racial issue or a cultural issue ; it s a simple affair of self-preservation. It s the manner to maintaining our state great and maintaining those unwanted for our state out. It s manner past clip to happen a remedy for the Immigration Cancer. Plants Cited Conover, Ted. A Journey Through the Secret World of America # 8217 ; s Illegal Aliens. Vintage, 1987. Opinion, The Immigration Crisis. , SF Chronicle, July 4th 1998 Dan Carney, # 8221 ; Social Policy # 8221 ; Congressional Quarterly Weekly Report, 9/7/96, Vol. 54 Issue 36, p250 334

Is There A God This Has Been One Of The Most Debated Questions Of Man

Is there a God? This has been one of the most debated questions of mankind. Religious icons, historians, archeologists, and others have questioned, investigated, and again questioned the existence of God. In his Discourse on Method, Ren? Descartes attempts to answer this question by means of a meticulous process. He means to guide his readers by the hand to arrive at his assertion that there is, in fact, a ?Nature more perfect than [ourselves]? (Potter 29) In Part IV of the Discourse on Method, Descartes attempts to convince his readers of the certain existence of a superior being. This is a very strategic method on Descartes' part. After reading three full sections of Descartes' diatribe on how they should go about life, readers are entrapped in a world of doubt; a world to which Descartes has led them, and a world in which he is the only one able to get them out. While in Descartes' world of doubt, the reader finds him or herself stumbling upon a somewhat lengthy paragraph concerning the existence of God. After reading this paragraph, the reader is convinced that Descartes is correct in his claim, for he led the reader by the hand through his discourse, and his proof of God. Following Descartes' idea that everything must have a cause, and the cause must have as much reality as the effect, Descartes proves the existence of God. Descartes also uses his cogito to support his logical progression. This progression is as follows: He has an idea of God, an infinitely perfect being; the idea of God has formal existence; whatever has formal existence must have a formally existing cause; there must be as much total perfection in the cause of the idea as there is in the idea itself; his idea of God has infinite total perfection; therefore, God has formal existence. He has broken his process down to the bare essentials for the reader. This is what convinces that Descartes is correct. His method is so simple, so concise, that any doubting reader is convinced by the mere simplicity of his argument. He continues once this is established. He asserts that a Perfect Being must exist, for he knows he is not perfect, therefore something must be perfect. He is certain that he is not perfect, because he also asserts that assuredness is more perfect than doubt. Since Descartes is constantly doubting, his claim is entirely valid. Specifically, he states that: I must hold this notion from some Nature which in reality was more perfect. As for the thoughts of many other objects external to me, as of the sky, the earth, light, heat, and a thousand more, I was less at a loss to know whence these came; for since I remarked in them nothing which seemed to render them superior to myself, I could believe that, if these were true, they were dependencies on my own nature, in so far as it possessed a certain perfection, and, if they were false, that I held them from nothing, that is to say, that they were in me because of a certain imperfection of my nature. But this could not be the case with the idea of a nature more perfect than myself. . . (29) This is the another piece of the foundation of Descartes' argument for the existence of a God. Descartes uses everything that he perceives to support his argument. In other words, he asserts that all that he perceives must come from somewhere, and if all that he perceives are falsities of his senses, this is simply another testament to his imperfection. Descartes has proved the existence of a perfect being. This perfect being, however, does not canote all that the reader thinks of when he or she thinks of, ?God?. Descartes has merely proven the existence of a being that is perfect. Descartes' God is somewhat of a representation of his own imperfections, for the Perfect Being that he describes does not doubt, knows all, and sees all as clear and distinct. In his third meditation, he elaborates further into his existence of God. Descartes has the hypothesis of an evil demon deceiving him all the time. Descartes uses yet another brilliant

Free Essays on Revolución Francesa

à ndice 1. Introduccià ³n ................................................................3pg. 2. Contenido ...................................................................5pg 3. Conclusià ³n .................................................................27pg. 4. Bibliografà ­a .................................................................28pg 5. Anexos ........................................................................30pg. Introduccià ³n En la historia del mundo contemporneo, la revolucià ³n francesa significà ³ el trnsito de la sociedad estamental, heredera del feudalismo, a la sociedad capitalista, basada en una economà ­a de mercado. La burguesà ­a, consciente de su papel preponderante en la vida econà ³mica, desplazà ³ del poder a la aristocracia y a la monarquà ­a absoluta. Los revolucionarios franceses no sà ³lo crearon un nuevo modelo de sociedad y estado, sino que difundieron un nuevo modo de pensar por la mayor parte del mundo. El final del siglo XVIII fue una à ©poca de trastornos en muchas partes de hemisferio occidental, trastornos que se pueden atribuir, directa o indirectamente, al fermento de las ideas conocidas como la Ilustracià ³n. Estas ideas, reflejo de las necesidades y tensiones de una sociedad cambiante se basan en el nuevo conocimiento cientà ­fico del siglo XVII, que engendrà ³ una nueva fe en la razà ³n y en el progreso. por un lado, esto llevà ³ a un rechazo de la autoridad y a una afirmacià ³n de los Derechos del Hombre, expresados en la famosa declaracià ³n de Rousseau de que el hombre nace libre, pero en todas partes est encadenado. Por otro lado, las nuevas ideas fueron una inspiracià ³n para los monarcas, que al ternar el siglo XVII, empezaron a concentrar el poder en sus propias manos y a gobernar mediante agentes burocrticos nombrados por ellos. Sin embargo, estas actividades centralizadoras encontraron resistencia en todos aquellos que tenà ­an intereses creados en el Ant iguo rï ¿ ½... Free Essays on Revolucià ³n Francesa Free Essays on Revolucià ³n Francesa à ndice 1. Introduccià ³n ................................................................3pg. 2. Contenido ...................................................................5pg 3. Conclusià ³n .................................................................27pg. 4. Bibliografà ­a .................................................................28pg 5. Anexos ........................................................................30pg. Introduccià ³n En la historia del mundo contemporneo, la revolucià ³n francesa significà ³ el trnsito de la sociedad estamental, heredera del feudalismo, a la sociedad capitalista, basada en una economà ­a de mercado. La burguesà ­a, consciente de su papel preponderante en la vida econà ³mica, desplazà ³ del poder a la aristocracia y a la monarquà ­a absoluta. Los revolucionarios franceses no sà ³lo crearon un nuevo modelo de sociedad y estado, sino que difundieron un nuevo modo de pensar por la mayor parte del mundo. El final del siglo XVIII fue una à ©poca de trastornos en muchas partes de hemisferio occidental, trastornos que se pueden atribuir, directa o indirectamente, al fermento de las ideas conocidas como la Ilustracià ³n. Estas ideas, reflejo de las necesidades y tensiones de una sociedad cambiante se basan en el nuevo conocimiento cientà ­fico del siglo XVII, que engendrà ³ una nueva fe en la razà ³n y en el progreso. por un lado, esto llevà ³ a un rechazo de la autoridad y a una afirmacià ³n de los Derechos del Hombre, expresados en la famosa declaracià ³n de Rousseau de que el hombre nace libre, pero en todas partes est encadenado. Por otro lado, las nuevas ideas fueron una inspiracià ³n para los monarcas, que al ternar el siglo XVII, empezaron a concentrar el poder en sus propias manos y a gobernar mediante agentes burocrticos nombrados por ellos. Sin embargo, estas actividades centralizadoras encontraron resistencia en todos aquellos que tenà ­an intereses creados en el Ant iguo rï ¿ ½...

The 10 Best Art Schools in the United States

The 10 Best Art Schools in the United States SAT / ACT Prep Online Guides and Tips If you have a passion for art, you should go to a college that will nurture your creativity. An art school will help you to develop your skills and learn more about what it takes to succeed in the professional world of art and design. In this article, I'll give you the details on what defines a great art school and provide a list of the best art colleges in the country for undergraduate students. How Is an Art School Defined for This List? On this list of the best art schools in the United States, I only included schools that exclusively cater to art and design students. Keep in mind that there are many other colleges that have excellent art programs but are less specialized. Colleges like Yale, UCLA, Tufts, and Columbia also have fantastic art programs. I didn't include those schools because this list is geared towards students who are absolutely certain that they want to study art at the college level (and would like to be in an environment with similarly-minded people). There are huge advantages to going to a specialized art college if you fall into this category of students. You will make friends with other people who share your interests and who may inspire you to expand your creative horizons. You also will have the benefit of being in a place where art is never a secondary concern. Career services will be devoted to helping students in artistic fields break into the job world, and you can usually make even better connections with working artists at these schools. If you know that you plan on studying in an artistic field, the schools on this list are great college options. At a school full of art students, everyone has paint on their hands at all times, and you can be as pretentious as you want without facing judgment! What Makes These Art Schools the Best? There are several factors to consider in determining what makes an art school great. First of all, it should have a diverse and modern curriculum. A great art school equips students with the skills they need to enter a rapidly changing, highly competitive job market. It should offer a wide variety of programs that are in step with current artistic trends and movements. The best art schools are invested in providing students with instruction in design practices that are shaping the world’s creative landscape today. A great art school should have excellent facilities for students, with access to the latest technology and artistic tools. Many of the schools on this list have extensive digital labs, on-campus art museums, and workshops that provide students with the ability to practice metalworking, laser cutting, woodworking, and other less accessible artistic disciplines. The quality of the faculty is important as well. The best art schools employ professors who are also successful working artists and leaders in their fields. Reputation is another factor that ties into this. If the alumni of a school have been successful in their careers, the school will have better name recognition and provide you with more future opportunities. The schools on this list have strong combinations of these qualities (and more!). They encourage students to think critically about art-making in the context of modern society and provide students with great opportunities to find their niche within the exciting world of art and design. The art world is always in flux. Is this "graffiti" or "street art"? Or is it both? As methods and standards change, so do the curricula at art schools! The Best Art Schools in the US For each of the schools on this list, I will provide admissions statistics and information about application requirements. I’ve also listed a few facts that will give you a sense of what these institutions offer to undergraduate art students. #1. Rhode Island School of Design: Providence, RI Statistics Undergraduate enrollment: 1,976Acceptance rate: 29%Average GPA: 3.7Average SAT score: 1300Average ACT score: 28 Special Requirements Prospective applicants are urged to follow a college preparatory program in secondary school, taking courses in studio art and art history where possible. A portfolio submission is required for admissions consideration. Your portfolio should show a selection of 12–20 examples of your best recent artwork. This work may be presented in any medium (including film or video) in either finished or sketch form. It can be the result of an assigned project or a self-directed artistic exploration. You’ll also need to send in two drawing samples. For more details, see the admissions website. Notable Facts The campus museum displays over 80,000 works of art, so inspiration abounds! RISD offers advanced tools and resources to its students, including laser cutters and a kiln room. RISD also employs many famous faculty members like Chris Van Allsburg (who illustrated The Polar Express!). Rhode Island School of Design #2. School of the Art Institute of Chicago: Chicago, IL Statistics Undergraduate enrollment: 2,889Acceptance rate: 61%Average GPA: 3.5Average SAT score: Not reported Average ACT score: Not reported Special Requirements In order to be considered for admission, you will need to submit an artist’s statement that represents you and your work. You are also required to submit a portfolio that showcases 10-15 examples of your best and most recent work. There are no limitations on the artistic medium! Notable Facts The School of the Art Institute of Chicago has a facility called the Computer Resources and Information Technologies Center, which ensures that students get access to and training on the latest digital equipment. There are also unique program offerings like art therapy and visual communication. SAIC has many distinguished alumni, including Walt Disney. School of the Art Institute of Chicago #3. California Institute of the Arts: Valencia, CA Statistics Undergraduate enrollment: 984Acceptance rate: 24%Average GPA: Not reportedAverage SAT score: Not reportedAverage ACT score: Not reported Special Requirements You are required to submit 20 examples of your most recent and highest quality independent artwork for your portfolio. You’ll also need to include an artist’s statement. Notable Facts All faculty members at the California Institute of the Arts are working artists with lots of real world artistic experience. Every student is assigned a mentor who guides them through the program and assists them in independent study. CalArts has eight galleries dedicated to showing student work and helping students get accustomed to hanging and presenting art in various forms. The school provides extensive facilities for student use including various media labs and a â€Å"Super Shop† for processes such as woodworking, metalworking, and moldmaking. I'm not sure why they chose to go with "CalArts" as the shortened version of the school's name when CIA was an option. California Institute of the Arts #4. Pratt Institute: New York, NY Statistics Undergraduate enrollment: 3,439Acceptance rate: 50%Average GPA: 3.77Average SAT score: 1300Average ACT score: 26 Special Requirements You are required to submit a portfolio that includes 12-20 examples of your best work. You must also submit three to five observational drawings to demonstrate your drafting skills. Notable Facts Pratt is located in New York City, so you’ll have access to all kinds of great internship opportunities and connections to the art world. Faculty members are working artists with international reputations as well as dedicated teachers. Students get free access to the Frick Collection, the MOMA, the Whitney Museum, and more. Pratt Institute #5. Maryland Institute College of Art: Baltimore, MD Statistics Undergraduate enrollment: 1,694Acceptance rate: 62%Average GPA: 3.5Average SAT score: 1180Average ACT score: Not reported Special Requirements You must submit a portfolio of 12 to 20 pieces of artwork for consideration. Notable Facts The Maryland Institute incorporates internships and other professional development activities into its curriculum to give students a strong foundation for careers in the arts. There are over 150 exhibitions per year by Maryland Institute students, faculty, and visitors. A strong advising system guides students through all four years at MICA. Maryland Institute College of Art #6. ArtCenter College of Design: Pasadena, CA Statistics Undergraduate enrollment: 2,005Acceptance rate: Not reportedAverage GPA: Not reportedAverage SAT score: Not reportedAverage ACT score: Not reported Special Requirements There are different portfolio requirements for different majors, but, in general, you are required to submit 10 to 15 pieces of artwork. See the admissions site for more details. Notable Facts This school is for students who know exactly what they want to do: Art Center gives students a comprehensive education in their chosen discipline starting on day one and there is no first-year general education program. However, the Transdisciplinary Studios program also allows students to collaborate with each other across different majors. Art Center College of Design partners up with companies and organizations in their Designmatters program to sponsor student projects that will make a real impact on the world. ArtCenter College of Design #7. California College of the Arts: Oakland, CA Statistics Undergraduate enrollment: 1,486Acceptance rate: 64%Average GPA: Not reportedAverage SAT score: Not reportedAverage ACT score: Not reported Special Requirements First-year applicants are asked to submit 10 to 20 images of their best work as a portfolio sample. Notable Facts The faculty is comprised of leaders in various artistic fields, and one-on-one attention is common (average student-teacher ratio is 8:1). CCA includes a First Year Program that introduces students to studio practice and incorporates a portfolio review at the end of the year to assess students’ readiness for the majors. There is also a First Year Student Exhibition every year. CCA offers numerous resources for professional development and networking in the arts that will help students to start fulfilling careers. #8. School of Visual Arts: New York, NY Statistics Undergraduate enrollment: 3,752Acceptance rate: 72%Average GPA: 3.3Average SAT score: Not reportedAverage ACT score: Not reported Special Requirements You will need to submit a statement of intent describing why you’re pursuing undergraduate study in the visual arts. You must also submit images of 15-20 pieces of your best work for your portfolio. You can decide to submit a film reel instead if you’re interested in studying film. Notable Facts There are three galleries at SVA that present over 50 exhibitions every year, so students have frequent opportunities to show their work. SVA has an Internship for Credit program that allows students to work with top creative agencies in New York City. The Digital Imaging Center and Print Lab offers extensive technological resources to students studying graphic design and advertising or enrolled in classes at the Center. School of Visual Arts #9. Parsons the New School for Design: New York, NY Statistics Undergraduate enrollment: 6,695Acceptance rate: 51%Average GPA: 3.4Average SAT score: 1200Average ACT score: 26 Special Requirements Prospective applicants must complete the â€Å"Parsons Challenge,† an artistic project exploring something that is usually overlooked in their environment. See the admissions site for more details on this. (I kind of want to do it just for kicks!) Applicants must also submit a portfolio of 8-12 pieces of recent artwork and an artist’s statement. Notable Facts Parsons incorporates digital arts strongly into its undergraduate curriculum, particularly in first-year coursework. Parsons also has a special first-year study program that teaches students to think creatively across different disciplines. With its location at the center of the New York art scene, this is a great place for students to explore different methods of art-making and learn how to turn their creative passion into a career. Parsons The New School for Design #10. Massachusetts College of Art and Design: Boston, MA Statistics Undergraduate enrollment: 1,931Acceptance rate: 71%Average GPA: 3.4Average SAT score: 1170Average ACT score: 24 Special Requirements You must submit a portfolio with 15-20 examples of your strongest and most recent artwork. You will also need to include a statement of purpose that describes you as an artist. Notable Facts MassArt is the nation’s first independent public college of art and design. The college has seven on-campus gallery spaces, routinely featuring work from students, faculty, and visiting artists. Degrees are offered in a wide variety of disciplines, from Industrial Design to Animation to Art Education. Massachusetts College of Art and Design Which Art School Is the Best Choice for You? All of the schools on this list will give you a great education in the arts, but some of them might be better fits than others for you and your interests. Location is a big factor to consider in deciding on the right art school for you. A few of these schools are located in the heart of New York City, which might be an awesome place for some students but an overwhelming place for others. Learn more about the differences between colleges in urban and rural environments. You should also consider the program offerings of each school. The School of Visual Arts, for example, is a great place for film majors. Parsons is a great place for students who are interested in fashion and digital arts. If you're still not sure exactly what you want to study in the arts, you should choose a school that has a first-year general education program and a strong advising system like California College of the Arts. If you are sure of what you want to study, you might choose a school like Art Center College of Design, which allows students to begin working in their chosen major from day one without any general education requirements. Admissions statistics are important as well. If your grades aren't spectacular, you should look for a school where admission is granted mainly based on artistic talent and a lower GPA and test scores won't ruin your chances. Some of these schools can be very competitive, but if you present an impressive portfolio, you can expect to have a shot at admission. What's Next? If you're planning on going to art school, you'll need to create a portfolio of your best work. Learn more about how to make a great portfolio that will impress your dream school. Interested in studying film? Read our article on how to get into film school. Are you worried about how your test scores might affect your chances of attending college? This article will tell you when SAT and ACT scores don't matter in the admissions process. Want to improve your SAT score by 160 points or your ACT score by 4 points? We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now:

Western civ (Greeks Vs, Hebrews) Essay Example | Topics and Well Written Essays - 500 words

Western civ (Greeks Vs, Hebrews) - Essay Example Consequently, the Greek system prepared individuals to serve the state while the Hebrew system prepared individuals to serve God. There is little question that religion played an important part in the social lives of both civilizations but dogmatic religious practices are more readily associated with the Hebrew tradition. In similar fashion, the political realities of the day reflected the intrusion of religion into the affairs of the state. The Hebrews believed that God would hold everyone accountable one day so the ruler was expected to be accountable to God alone. In contrast, the Greek system of personal accountability relied on philosophy and on the discretion of fellow men. Hence, the Greek ruler was accountable to his fellow men more than his accountability to any gods. This increased accountability paved for the world’s first democracy in Athens (Blainey). The achievements of various Athenians such as Aeschylus, Sophocles, Euripides, Herodotus, Thucydides, Hippocrates, Socrates, Plato and Aristotle among others laid the foundation for the modern Western civilization. The move to democracy strengthened the Greek quest for knowledge. Furthermore, the Greeks had managed to disassociate divinity with exploration of things around them. Even after Athens was subsumed into the larger Greek civilization, the traditions of learning and development continued unabated. The epistemological drive of the Greeks led to developments in science, architecture, law, philosophy, commerce and numerous other fields. A rich scientific tradition can be traced back to the Greeks with names such as Archimedes, Hero of Alexandria, Galen and others appearing in scientific discussions to this day (Thornton). In contrast, the Hebrew tradition kept God intact with learning limitations. God was seen as the center of the universe in the literal sense and ideas upheld by the scripture were unquestionable. The strength of the Hebrew tradition of

Competing In The Global Arena Essay Example | Topics and Well Written Essays - 4250 words

Competing In The Global Arena - Essay Example Why is Apple holding so much cash Having too much cash in reserve might either mean that the company does not know yet how to allocate it or that they may have some risk concerns about future potential investment. Apple is obviously one of the handful of companies where the fortunes are seen to be intricately tied to the person in charge. The star excellence and the thinker talents linked by professionals Jobs are certainly contributed to the success of the company. So the news of Jobs' cancer surgery might lead to a succession problem and compromise the company's future. Apple achieved a solid performance for the first quarter of 2005 compared to the same quarter 2004 with strong net sales in the Americas segment (+77%) in Europe (+63%) and in Japan (+18%). The Americas segment represents approximately 47% of the company's total net sales. The increase in net sales in the Americas, Europe and Japan was primarily driven by increased demand of the iPod and the consumer-oriented iMAC (Apple Computer, Inc. (AAPL), 2006). Demand for the iBook products were especially high for the Americas, while peripherals and other hardware were more popular in Europe. The retail segment's net sales grew to $561 million as compared to $273 million in the same period in 2004, this represents a remarkable 105% increase. B. Strategic Posture Mission Apple strives for continuous improvement in our environmental, health and safety management systems and in the environmental quality of our products, processes and services (Environmental Health and Safety Policy Statement, 2006). Apple's Guiding Principles Meet or exceed all applicable environmental, health and safety requirements. Where laws and regulations do not provide adequate controls, Apple will adopt their own standards to protect human health and the environment (Apple and the Environment). Support and promote sound scientific principles and fiscally responsible public policy that enhance environmental quality, health and safety. Advocate the adoption of prudent environmental, health and safety principles and practices by their contractors, vendors and suppliers (Environmental Health and Safety Policy Statement, 2006). Communicate environmental, health and safety policies and programs to Apple employees and stakeholders. Design, manage and operate our facilities to maximize safety, promote energy efficiency and protect the environment. Strive to create products that are safe in their intended use, conserve energy and materials and prevent pollution throughout the product life cycle including design, manufacture, use and end-of-life management (Environmental Health and Safety Policy Statement, 2006). Ensure that all employees are aware of their role and responsibility to fulfill and sustain Apple's environmental, he

Broad Environment Essay Example for Free

Broad Environment Essay Knowing the Unknown about the Broad Environment University of Tampa MGT 431 Practical Strategic Assessment Dr. George Bud Wynn June 09, 2009 Abstract In â€Å"Foundations in Strategic Management†, pages 21 to 27, author Harrison discusses the influence that the external environment has on a particular company’s operations and how its managers can adapt to environmental uncertainties to sustain their competitive advantages. Harrison also points out why it is important for firm to analyze and evaluate its broad environment. He also mentions how managers can analyze and evaluate external forces and devise strategies to complement the rapid-changing environment in order for their company to be competitive throughout and take advantage of its strengths and minimize its threats. He further divides the broad environment into four sub-headings (socio-cultural, economical, technological and political/legal) and states why each is important and the effect each have on a company’s operations. The purpose of the paper focuses more on informing the reader of the importance of evaluating a particular company’s broad environment. The paper also includes a review of and my opinion on what I think firms and their managers should be aware of when it comes to their company’s broad environment. The Importance of the Broad Environment to Managers Before the 1990’s, if a business had a competitive advantage and opened its doors to the general public, it was almost guaranteed success. However, such cases no longer exist. In modern times, companies with competitive advantages such as sufficient resources, skilled workers, superior technologies and the like can still go under due to the ever-changing environment. Nowadays, successful businesses are shifting focus from just having a competitive advantage in one or two areas, to maximizing on the relevant information that its managers have about its operation environment; including the broad and task environment. In order to operate a successful business, it is important for managers to have a comprehensive understanding of its broad environment in which it plans to operate. The broad environment includes socio-cultural, economical, technological, and political/legal forces which have an effect on how the company plans to gain a profitable market share. Such comprehensive understanding allows managers to save valuable time and money; subsequently making their business profitable. Due to the uncertainties of the rapidly changing economy, it is almost required by top performing firms to research the broad environment; even if its plan to merge or joint venture with another firm elsewhere. In addition, such research is also highly recommended for companies that plan to do business globally; if the company wishes to create a buffer from potential losses. Also, companies that analyze the broad environment effectively are able to maximize its advantages and opportunities while limiting weaknesses and threats. In conclusion, successful firms must recognize the importance of the broad environment in order to take advantage of its strengths and opportunities while minimizing its weaknesses and threats. Well-defined researches coupled with a complete understanding of a company’s broad environment are always important because, when done properly, it can enable companies to seize potential market areas and dominate a particular geographical location. Maintaining a complete understanding of the broad environment is vital to a company’s success. Understanding the broad environment is important for many reasons. Socio-cultural forces occur randomly and without warning. Many firms experience difficulties with these forces many times during operations. Examples of socio-cultural forces range from the influence of terrorism on the economy to the legality of abortion. Proper socio-cultural assessment enables firms to minimize its threats from potential restrictive legislation. Firms which are aware of pending restrictive law changes can avoid huge fines and penalties. In addition, managers should spend ample time researching law changes in order to save their company from falling intothese traps. Managers who are aware of demographic and economic changes in society can take advantage of opportunities that their competition fails to recognize. For example, a careful study of a firm’s social environment can gather information on what products/services or lifestyles people from a particular neighborhood purchase or prefer. In conclusion, a thorough understanding of socio-cultural forces can enable managers to gain from their knowledge about its societal operations and make it work to the best interest of their business. This will enable them to take advantage of strengths while also minimizing their threats. Economic forces play a critical part in the understanding of a firm’s broad environment. Factors such as interest rates, economic growth and inflation are important variables which managers must be aware of in order to process their broad environment effectively. Without such knowledge, it would be almost impossible to run an effective and efficient business and establish a competitive advantage. Furthermore, information gained from economic forces enables managers to allocate resources while allowing time to seek other investment opportunities. For example, multinational firms can benefit from favorable exchange rates. In order words, an understanding of fluctuations in exchange rates can lead such firms to purchase raw materials in countries where their own currency is superior to that of the foreign country. On the other hand, without knowledge of inflation, companies can suffer huge losses when investing in these countries. As a result, managers must be aware of such economical changes beforehand in order to make educated decisions that can assist their company’s growth and production. Another broad environment which managers should be aware of is technology. Nowadays, technology is changing the ways individuals and firms do business. New innovations such as the internet, handheld computers, and direct satellite systems are making it much easier for firms to purchase, deliver, and sell its products/services. Firms must be aware of and adapt to new technological changes in order to stay ahead of its competition in the fight for market shares and profits. If not, these companies are bound to fail or file for bankruptcy. Most firms are pumping millions of dollars into research and development in order to find new ways of improving its product’s life cycle which will in turn, generate more revenue and satisfy customer. One of the world leaders in electronic supply, the Sony Corporation of America, has developed new ideas to save its customer time and money. As a result, Sony is one of the main leaders in its industry and continues to see profits soar in 2008. According to one official, one of its newest inventions, â€Å"Eye on Education†, â€Å"[e]ducation educators receive competitive pricing, exclusive service and support capabilities, financing options, and trade-in opportunities for Sony professional display products. † Technology awareness and continuous improvement in its research and department hasled the company to success over the years. In modern times, in order for any one company to be effective, managers must be aware of the technological forces that can assist their companies to save money, andtime; subsequently improving the business purpose and values. Finally, close attention must be geared towards political/legal forces which can change the company’s focus or purpose in one way or another. Government regulations can alter the ways in which companies wish to perform its business in terms of locally or globally. Therefore, managers must pay attention to different types of changes that their companies might undertake if there is a desire to join multiple or particular industries. Government normally provides advantages to some businesses in the form of tax incentives which promote ethical behavior and remind firms of its responsibilities. Managers who are vigilant can take advantage of these incentives. Overall, a comprehensive understanding of a company’s broad environment such as socio-cultural, economical, technological, and political/legal forces are an essential assessment that needs to be considered before a merger, joint venture, acquisition, or even to successfully run a business. On the other hand, trained personnel must carry out such researches in order to avoid huge losses and business failure. Also, integrated understanding coupled with awareness can provide managers with information on what types of products/services to offer, sell, customers, delivery, and the like to enable their business to accomplish its goals. Assessments are highly recommended for starting up and strugglingcompanies and businesses which wish to operate globally. If somehow a particular set of managers can make a reasonable assessment of its company’s broad environment, they are almost guaranteed to run an effective and efficient company.

The Effect of Concentration on the Rate of Reaction :: GCSE Chemistry Coursework Investigation

The effect of concentration on the rate of reaction between sodium thiosulphate and dilute hydrochloric acid This investigation is about rates of reaction and what affects them. In this case I am going to look at hydrochloric acid and sodium thiosulphate which is a precipitation reaction causing the solution to go 'cloudy'. They react as in the equations below: sodium thiosulphate + hydrochloric acid -> sodium chloride + sulphur + sulphur dioxide + water Na2S2O3(aq) + 2HCl(aq) -> 2NaCl(aq) + S(s) + SO2(g) + H2O(l) A reaction will only occur where the particles of the reactants meet and combine. This is called the collision theory. For a reaction to occur particles have to collide with each other. Only a small percent result in a reaction. This is due to the energy barrier to overcome. Only particles with enough energy to overcome the barrier will react after colliding. The minimum energy that a particle must have to overcome the barrier is called the activation energy, or Ea. The size of this activation energy is different for different reactions. If the frequency of collisions is increased the rate of reaction will increase. However the percent of successful collisions remains the same. An increase in the rate of reaction can be achieved by increasing the frequency of collisions. Therefore to increase the rate of reaction it is necessary to cause more particles to collide harder and collide more often. There are several ways to do this and these make up the factors for this experiment. They are listed below along with predictions as to their affect on the reaction. Possible Factors To make sure I carry out a fair test I will only change the concentration of sodium thiosulphate. I will keep the following factors the same. Increasing the pressure. By reducing the volume in which the same amount of particles exist the pressure is increased. Once the same number of particles are in a smaller area there is less space in which to move and so the particles are more likely to hit each other. It is therefore possible to predict that increasing the pressure will result in an increase in the rate of reaction. I will not test this variable because we don't have the facilities to test it. However pressure is a continuous variable. Catalyst. A catalyst is a separate substance that speeds up a reaction. After the reaction has happened it gets left behind. This makes this variable unsuitable for the type of experiment I am going to do. Temperature. By giving the particles extra energy they will move faster. This means that they cover more ground and are therefore more

Lab 5 Acid/Base Extractions Essay

The purpose of this experiment is to separate either the organic base (amine) or organic acid (carboxylic acid) from a mixture that contains inorganic impurities (salt) by performing a liquid-liquid extraction and then taking a melting point. Key Experimental Details and Observations Our starting material, Compound B, was a fine white powder and weighed 0.535g. The final product was a shiny white sheet that resembled acrylic paint and weighed 0.109g. Results Our percent yield was 0.109g/0.535g x 100 = 20.4%. Discussion and Conclusions The melting point ranges we got for compound B ranged from 110.8-114.0 Â °C, while the melting point range for benzoic acid is 121.0-123.0Â °C and 103.0-107.0Â °C for 4-amino acetophenone. Since the ranges we acquired for compound B are directly in between both acid and base melting points, we can conclude that the purity for compound B is relatively high due to the compound being made up of equal parts of benzoic acid and 4-amino acetophenone. Thus saying that our melting point ranges are fairly accurate because they exemplify an equal percentage of both compounds, which is exactly what compound B is made up of. The purity can also be concluded through the melting points depression because depression arises from impurities within the lattice of a crystalized sample. We acquired a percent yield of 20.4%, which is relatively low. This result could be from part of the compound B solution being left behind in the Erlenmeyer flask when pouring the solution into the vacuum filtrate. The efficiency of a liquid-liquid extraction is high because it did allow us to gain some of our starting product back. We were able to isolate the acid from the base by deprotonating the solution with 10mL of NaOH. This caused the benzoic acid to settle at the bottom of the separatory flask because the NaOH broke it into ions, which made the acid polar. We then protonated the solution by adding HCl, which cause the acid to separate from the solution.

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. 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