Tom Sawyer Essay -- essays research papers

Tom Sawyer Tom Sawyer was a boy, not one of the sort that you read about in good books, but a little devil, never malicious and always at some trick, and in the course of years he engaged in a multitude, all of which are here recorded in Twain's style. He had special aversions for church, Sunday school, pious people, devout conversation and the company of his sedate but good old aunt. In spite of his efforts to escape from such inflictions he had to suffer them once in a while, but in his efforts to get some diversion on such occasions he more than once made lively sensations. Too lazy to get his Sunday school lessons, he managed by sharp trading to buy up a lot of the tickets given to the best pupils, and when a distinguished visitor came the children were requested to step forward with their tickets so that the one who had the most should receive the prize. To the astonishment of all Tom Sawyer was the hero, and, after a great time had been made over him, the visitor thought Tom should have a chance to show his learning, so he asked him who were the first two of the twelve Apostles to follow Jesus, it being presumed that the prize boy knew such things perfectly, for the lesson of the term had been in the study of the four Gospels. Tom felt the necessity of giving some answer, and his was "David and Goliath," to the surprise of the visitor, the consternation of the head teacher and the amusement of the school. When Tom went to church he took a large snapping bug...

Black Holes Essay -- physics science black hole

When a star "dies" it can do many different things. It can form a neutron star, expand to a red giant and shrink into a white dwarf, or sometimes collapse upon itself to form a black hole. This is mostly dependent on the density of the star. When massive stars, those twenty times the mass of our Sun or more die, they must either exhaust all of their excess mass or implode upon themselves and form black holes. Gravity overwhelms even the nuclear forces. The gravitational force becomes so strong that nothing can escape it, even photons of light, hence the name "black" hole. It is believed that large black holes may exist at the center of our galaxy as well as others. The massive gravitational force that they exert would be enough to keep the body of the galaxy in orbit. A black hole consists of a few key things. The singularity is the center of the black hole, the point at which the matter is being compressed into a massive density. The event horizon is the point at which not even photons of light can escape the tremendous gravitational pull of the black hole. This makes it hard ...

Encourage Contact Between Students And Faculty Education Essay

In the universe, an country that has seen much investing is education. Knowledge or instruction was considered the â€Å" 3rd oculus † of adult male which gives him an penetration into all personal businesss. So many people from different age group spend a batch of their clip, money and attempts in prosecuting instruction in assorted establishments of larning. Old ages spent in primary, secondary schools, colleges and universities are about have a life-time in this instance, hence returns from such an investing should be high plenty to justify such attempt. Education is an investing to development, and hapless survey methods should non compromise the authorization of higher instruction establishment to bring forth, continue and circulate cognition and bring forth high quality alumnuss. Universities admit pupils with changing backgrounds in footings of learning/study manners, degrees of readiness and constructs of university instruction. Some were â€Å" drilled † , taug ht for tests, or have incorrect purpose / values of university acquisition. These negatively have impact on their survey accomplishments and accomplishment. In complementing the function played by academic staffs, pupils need to be witting of their survey personality and survey moralss as they influence analyzing. It is ineffectual to learn good while pupils lack the basicss to gestate and internalise the new cognition. Many times, college pupils have non had to pull off their clip expeditiously prior to college because they are bright and seldom challenged in high school. So some pupils who had ‘A ‘s and ‘B ‘s start receiving auxiliary tests and score C ‘s and D ‘s in college. Harmonizing to the National Commission on Excellence in Education ( 1984 ) , many pupils are unsuccessful in school because they lack effectual survey accomplishments. To counter this, the committee recommends that survey accomplishments be introduced to pupils really early in the schooling procedure and go on throughout a pupil ‘s educational calling. In a now authoritative survey of survey accomplishments, ( Entwistle, 1960 ) reported that pupils who voluntarily took a survey accomplishments class were more successful academically than similar pupils who did non voluntarily take the class. ( butcofsky, 1971 ) reported that pupils who have trouble in college often have unequal survey wonts that affect their academic accomplishment. A cardinal job, he noted, was that many of these pupils had non learned how to take effectual notes and manage clip for analyzing. To achieve an effectual survey in higher instruction we sometimes need guidelines and have to follow some certain regulations. We need to hold contact with pupils in our categories and module, as pupils and module members ; we have spent most of our school lives seeking to understand ourselves, and our establishments. And have conducted a small research on higher instruction with dedicate d pupils in a broad scope of schools. We draw the deductions of this study, trusting to assist us all do better, as we emphasizes clip on undertaking, respect diverse endowments and ways of acquisition, promote active acquisition, communicate high outlooks and several of them. But the ways different establishments implement good pattern depends really much on their pupils and their fortunes. In what follows, we describe several different attacks to good pattern that have been used in different sorts of scenes in the last few old ages.2.0 ECOURAGE CONTACT BETWEEN STUDENTS AND FACULTYFrequent student-faculty contact in and out of categories is the most of import factor in pupil motive and engagement. Faculty concern helps pupils get through unsmooth times and maintain on working. Knowing a few module members good enhances pupils ‘ rational committedness and encourages them to believe about their ain values and future programs. Forming seminars for freshers on of import subjects and these subjects will be taught by senior module members, this helps in set uping an early connexion between the fresh and senior pupils and the module in many colleges and universities. Faculty members who lead treatment groups in classs outside their Fieldss of specialisation theoretical account for pupils what it means to be a scholar. ( Arthur & A ; Zelda, 1987 ) In the Undergraduate Research Opportunities Program at the Massachusetts Institute of Technology, three out of four undergraduates have joined three-fourthss of the module as junior research co-workers in recent old ages. At Sinclair Community College, pupils in the â€Å" College without Walls † plan have pursued surveies through larning contracts. Each pupil has created a â€Å" resource group, ‘ which includes a module member, a pupil equal, and two â€Å" community resource † module members. This group so provides support and assures quality3. 0 DEVELOPS RECIPROCITY AND COOPERATION AMONG STUDENTSLearning is enhanced when it is more like a squad attempt than a solo race. Good acquisition, like good work, is collaborative and societal, non competitory and stray. Working with others frequently increases engagement in larning. Sharing one ‘s ain thoughts and reacting to others ‘ reactions sharpens believing and deepens understanding. Even in big talk categories, pupils can larn from one another. Learning groups are a common pattern, in which five to seven pupils run into on a regular basis during category throughout the term to work out jobs set by the teacher. Many colleges use peer coachs for pupils who need particular aid. Learning communities are another popular manner of acquiring pupils to work together. Students involved in Learning Communities can take several classs together. The classs, on subjects related to a common subject like scientific discipline, engineering, and human values, are from different subjects. Faculties learning the classs coordinate their activities while another module member, called a â€Å" maestro scholar: ‘ takes the classs with the pupils. Under the way of the maestro scholar, pupils run a seminar which helps them incorporate thoughts from the separate classs.4.0 MotivationAcademic success or failure can bring forth the feelings of competency or incompetency in pupils. These feelings can impact pupils ‘ public presentations by their willingness to go on to larn or give up. ( Haynes, 1993 ) â€Å" It is believed that pupils who have high accomplishment outlooks attribute success to internal and external causes † . There are several schemes that can be used to actuate pupils to larn. ( Tonjes & A ; Zintz, 1981 ) ( 1 ) â€Å" Identify pupil ‘s involvements and taking stuffs that meet the involvements, abilities, and attitudes of the pupils † . Teachers should be able to place what the pupils are interested in so they can assist them take actuate them on geting that involvement. ( 2 ) Give clear aims of the lessons and assignments. ( 3 ) ( Mutsotso & A ; Abenga, 2010 ) â€Å" Allow pupils to take the undertaking and stuffs to finish the undertaking † .5.0 COMMUNICATE HIGH EXPECTATIONExpect more and you will acquire more. High outlooks are of import for everyone, for the ill prepared, for those unwilling to exercise themselves, and for the bright and well-motivated. Expecting pupils to execute good becomes a self-fulfilling prognostication when instructors and establishments hold high outlooks of them and do excess attempts. E.g. ( Arthur & A ; Zelda, 1987 ) in many colleges and universities, pupils with hapless yesteryear records or trial tonss do extraordinary work. Sometimes they outperform pupils with good readying. The University of Wisconsin-Parkside has communicated high outlooks for underprepared high school pupils by conveying them to the university for workshops in academic topics, survey accomplishments, trial pickings, and clip direction. In order to reenforce high outlooks, the plan involves parents and high school counsellors6.0 ACADEMIC INVOLVEMENTDefined as a composite of self-reported traits and behaviours ( e.g. , the extent to which pupils work hard at their surveies, the figure of hours they spend analyzing, the grade of involvement in their classs, good survey wonts ) , academic engagement produces an unusual form of effects. Intense academic engagement tends to retard those alterations in personality and behaviour that usually result from college attending. Therefore, pupils who are profoundly involved academically are less likely than mean pupils to demo additions in liberalism, hedonism, artistic involvements, and spiritual renunciation or decreases in concern involvements.7.0 ACTIVE LearningLearning is non a witness athletics. Students do non larn much merely by sitting in categories listening to instructors, memorising prepacked assignments, and ptyalizing out replies. They must speak about what they are larning, write about it, associate it to past experiences and use it to their day-to-day lives. They must do what they learn portion of themselves. Active acquisition is encouraged in categories that use structured exercisings, disputing treatments, squad undertakings, and equal reviews. Active acquisition can besides happen outside the schoolroom. There are 1000s of internships, independent survey, and concerted occupation plans across the state in all sorts of colleges and universities, in all sorts of Fieldss, for all sorts of pupils. Students besides can assist plan and learn classs or parts of classs. At Brown University, module members and pupils have designed new classs on modern-day issues and cosmopolitan subjects ; the pupils so assist the professors as learning helpers. At the State University of New York at Cortland, get downing pupils in a general chemical science lab have worked in little groups to plan lab processs instead than reiterate restructured exercisings. At the University of Michigan ‘s Residential College, squads of pupils sporadically work with module members on a long-run original research undertaking in the societal scientific disciplines.8.0 TIME MANAGEMENT AND HANDLING STRESS( Alexander, 1999 ) College decision makers are invariably preoccupied with the accretion and allotment of financial resources ; the theory of pupil engagement, nevertheless, suggests that the most cherished institutional resource may be student clip. Harmonizing to the theory, the extent to which pupils can accomplish peculiar developmental ends is a direct map of the clip and attempt they devote to activities de signed to bring forth these additions. For illustration, if increased cognition and apprehension of history is an of import end for history big leagues, the extent to which pupils reach this end is a direct map of the clip they spend at such activities as listening to professor ‘s talk about history, reading books about history, and discoursing history with other pupils. By and large, the more clip pupils spend in these activities, the more history they learn. Stress is any state of affairs that evokes negative ideas and feelings in a individual. The same state of affairs is non redolent or nerve-racking for all people, and all people do non see the same negative ideas and feelings when stressed. One theoretical account that is utile in understanding emphasis among pupils is the person-environmental theoretical account. ( Lazarus, 1966 ) Harmonizing to one fluctuation of this theoretical account, nerve-racking events can be appraised by an person as â€Å" disputing † or â€Å" baleful † . When pupils appraise their instruction as a challenge, emphasis can convey them a sense of competency and an increased capacity to larn. When instruction is seen as a menace, nevertheless, emphasis can arouse feelings of weakness and a fateful sense of loss. A critical issue refering emphasis among pupils is its consequence on acquisition. ( The Yerkes-Dodson jurisprudence 1908 ) postulates that persons under low and high emphasis learn the least, and that those under moderate emphasis learn the most. A field survey and research lab trials support the impression that inordinate emphasis is harmful to pupils ‘ public presentation. Mechanisms that explain why pupils perform severely under emphasis include â€Å" hyper watchfulness † ( inordinate watchfulness to a nerve-racking state of affairs ensuing in terror — for illustration, over analyzing for an test ) and â€Å" premature closing † ( rapidly taking a solution to stop a nerve-racking state of affairs, for illustration, hotfooting through an test ) . Students react to Higher Education in a assortment of ways. For some pupils, college or the University is nerve-racking because it is an disconnected alteration from high school. For others, separation from place is a beginning of emphasis. Although some emphasis is necessary for personal growing to happen, the sum of emphasis can overpower a pupil and impact the ability to get by. Time ON TASK Time plus energy peers larning. There is no replacement for clip on undertaking. Learning to utilize one ‘s clip well is critical for pupils and professionals likewise. Students need aid in larning effectual clip direction. Allocating realistic sums of clip agencies effectual larning for pupils and effectual instruction for module. How an establishment defines clip outlooks for pupils, module, decision makers, and other professional staff can set up the footing for high public presentation for all. E.g. ( 1 ) ( Mutsotso & A ; Abenga, 2010 ) larning how to finish assignments on clip will assist pupils succeeds academically. In the â€Å" Dynamics of Effective Study † pupils are taught how to form and pull off clip sagely. Students are taught how to schedule undertakings hebdomadal and monthly to guarantee success. To heighten the academic accomplishment of pupils, a survey accomplishments class was implemented in the course of study to assist pupils achieve the GPA standa rds. Freshmans have enrolled in this class since it was implemented in 1994. This survey will analyze the effectivity of the class, â€Å" Dynamicss of Effective Study, † on the academic accomplishment of freshers at this school. ( 2 ) ( Arthur & A ; Zelda, 1987 ) Mastery acquisition, contract acquisition, and computer-assisted direction require that pupils spend equal sums of clip on larning. Extended periods of readying for college besides give pupils more clip on undertaking. Matteo Ricci College is known for its attempts to steer high school pupils from the 9th class to a B.A. through a course of study taught jointly by module at Seattle Preparatory school and Seattle University. Supplying pupils with chances to incorporate their surveies into the remainder of their lives helps them usage clip good. As pupils in higher instruction, much is expected of us, and at the same clip there are so many distractions that come our manner. We need to be able to get the better of this distractions, know what to make at a peculiar point in clip, cognize when to acquire a school assignment done so that the work burden wo n't be much, and when to go to to other things. And most significantly know when to make these things at the right clip. So for us to be able to accomplish these purposes in due clip we as pupils need to be able to modulate our clip. For Example You may be making a class with faculties, where each one must be completed in a semester. You might sometimes necessitate to get down assessed plants before you ‘ve had all the categories, to finish it on clip you need to be after yourself good You may be making several faculties at one time all with a similar deadline taking to bunching of plants. If you do n't be after for this you might stop up under force per unit area. If you leave it excessively late to look for indispensable resources, they may non be available. Advance planning is every bit indispensable as the resources If you ‘re making paid work while analyzing, you need to suit it all together. So many pupils have domestic duties to suit in with class work, this besides needs planning.THINGS HIGH IN IMPORTANCE, LOW IN URGENCY.( DAVID, 2009 ) For module and alumnus pupils, things that are extremely of import but less pressing tend to include our original research and our personal relationships. Both are evidently of import, and we know that. But the world is that both of these tend non to experience every bit pressing as our duties for a category. For illustration, calculating out how to research the communicating kineticss that propelled a state to travel to war is undeniably of import, yet it merely does n't transport the same sense of immediateness as prepping for a category that occurs tomorrow and so once more two yearss subsequently, for the following eight hebdomads. Similarly, traveling out to dinner with a close friend can ever be put off until another twenty-four hours, right? And that ‘s precisely what happens with things that are of import but non ( as ) urgent — we tend to force them to the side. As a consequence, many of us get the instruction and pupil work done foremost and merely so turn to a focal point on original research or personal clip that nurtures us. If such clip does non happen, and it frequently does n't, so so be it. And that ‘s the hang-up of the affair. We must do certain that we devote clip to things that are extremely of import, but low in urgency. If we do non, the nature of the academy is that extremely of import, extremely pressing undertakings will herd everything else out. When that occurs, burnout ensues. Here are a few stairss that we can take to do certain we give equal precedence to things high in importance and low in urgency: Schedule them.A If you do n't schedule them, they do n't go on. As a module member, I schedule my research clip and personal activities, to do certain they happen. Otherwise they wo n't. Make different things on different yearss of the week.A I have found that I am best when concentrating on one primary type of work undertaking a twenty-four hours. That is, if I teach on Tuesday so I likely wo n't be much good as a research worker that twenty-four hours. For me, Mondays and Fridays tend to be yearss that I spend making chiefly research and commission work. Believe that you will really be a better instructor and pupil when you do take clip to plunge yourself in what is extremely of import, but non ( as ) urgent.A I ‘m wholly convinced that when I prioritize occasional pockets of personal clip I enrich my instruction and research because my head and energy are renewed.9.0 DecisionHow much a pupil achieves is in portion dependant on the survey methods that he/she applies. There is no 1 survey method that works better for all individuals. The secret lies in being able to place personal survey methods that work for each person in given environments, conditions and fortunes. This requires cognizing oneself in order to do good determinations about how to analyze and do clip, every bit good as know the assorted schemes that can be applied.

Concept Analysis of Pain

Concept Analysis of Pain Kwanei Holloway Austin Peay State University Abstract Pain has always been a major factor in healthcare. This paper will describe pain as it relates to nursing, medicine, and physical therapy. All of the information gathered is analyzed in reference to how pain relates to hospital stay, rehabilitation, and prevention. I will ultimately give an overall picture of the importance of pain and how it relates to nursing as well as other disciplines. Introduction This paper is a concept analysis of what is known as the fifth vital sign PAIN.As stated by Hsiao, Wu, & Chen (2013), Nursing staff are the major group of healthcare professionals who perform crucial functions in delivering nursing care to inpatients. I will attempt to describe pain as it relates to nursing, medicine, and physical therapy. When selecting a concept, I began by thinking what is an important factor in the nursing field and could be analyzed in more detail. Pain is a factor that is thought of d ifferently by many. It is a very subjective factor and that applies to the patients, physicians, and nurses.Yes, it is the patient that feels the pain but it is the physician who writes the orders and the nurse who transcribes it. I then figured that this area of nursing practice would be a great concept to analyze. Pain is a feeling triggered in the nervous system. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen or chest or you may feel pain all over, such as when your muscles ache from the flu. Pain can be helpful in diagnosing a problem.Without pain, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment. Once you take care of the problem, pain usually goes away. However, sometimes pain goes on for weeks, months or even years. This is called chronic pain. Sometimes chronic pain is due to an ongoing cause, such as canc er or arthritis (â€Å"Pain†). In the nursing field as well as any other areas of healthcare, pain is a vital factor when dealing with the delivery of care. It is the responsibility of he physician to ensure relief from pain by writing the orders, it is the responsibility of the nurse to carry out the orders and give the pain medication, and in the area of physical therapy it is their responsibility to ensure that the patient is medicated to retrieve the best results while in therapy. Purpose and Method The purposes are to define what pain is considered to be in relationship to the patient, nurse, physician, and physical therapist. It is also, to find out the subjectiveness of the fifth vital sign and to explore pain as it relates to hospitalization.Walker & Avant (2005) guided this concept analysis study. Pain in Nursing Almost 35 million patients were discharged from U. S. hospitals in 2004; of these patients, 46 percent had a surgical procedure and 16 percent had one or mo re diagnostic procedures. Pain is common, and expected, after surgery. Recent data suggest 80 percent of patients experience pain postoperatively with between 11 and 20 percent experiencing severe pain, (Wells, Pasero, & Mcraffery, 2008).There are many contributing factors as pain relates to nursing. Pain is the main factor that contributes to a person deciding to seek medical attention. It is very important to include this as a part of an assessment because it can affect so many other things. It can cause a blood pressure to be elevated, it can increase a blood glucose, and can cause an overall disturbance in the patients’ hospital stay or ADL’s. In nursing our aim is to provide comfort and surrccome to the patients’ needs as a part of their overall care plan.As stated by Wells, Pasero, & Mcraffery, 2008, inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. Continuous, unrelieved p ain activates the pituitary-adrenal axis, which can suppress the immune system and result in postsurgical infection and poor wound healing. Pain in Medicine Medical professionals have a big impact on pain as it relates to healthcare. Physicians have to generate a care plan that will ultimately be in the favor of the patient as far as relieving the pain in the most appropriate way.This is achieved by not altering consciousness, normal ADL’s, and in the correct combination with other medications. The board strongly urges physicians and surgeons to view effective pain management as a high priority in all patients, including children, the elderly, and patients who are terminally ill. Pain should be assessed and treated promptly, effectively and for as long as pain persists. The medical management of pain should be based on up-to-date knowledge about pain, pain assessment and pain treatment (â€Å"Guidelines for prescribing,† 2007).Nociception is the term used to describe t he neural processes by which a noxious substance or a tissue damaging event such as surgical incision is perceived as pain (Fig 1). This is described in four stages, transduction, transmission, perception and modulation. Nociception involves a complex interaction between the peripheral nervous system (PNS) and central nervous system (CNS) as well as an evaluation of patients’ pre and post-operative psychological and environmental influences (Wood, 2010). Pain in Physical TherapyDue to factors such as surgery, stroke, or basic deconditioning there is a need for rehabilitation. Physical Therapist play an essential role in the patients’ road to recovery. A patient-centered rehabilitative approach that emphasizes restoration of normal movement and function incorporates physical therapy as a vital component of the collaborative approach required for effective pain management (â€Å"Physical therapy for,† 1998). Overall therapy is lessened with pain. Patients move slo wer and are less involved with therapy if pain is present.Therapy is put into place to get those muscles moving and to later decrease pain as it relates to contributing factors. These factors may include surgeries (hip or knee replacements), amputations (AKA, BKA, Metatarsal, and digital), and weakness (from CVA, CABG, and decrease movements). Patients with pain perceive an equivalent level of exertion at a significantly lower level of performance, a finding accounted for by both central (cardiorespiratory) and peripheral (muscle strength and recruitment) factors.Inactivity also deprives bones, joint cartilage, and connective tissue of the mechanical stress necessary to maintain tensile and compressive strength and elasticity. Evidence is building that motor control and proprioceptive efficiency are altered, balance is compromised, and reaction times are slower in persons who are unfit or have pain (â€Å"Physical therapy for†, 1998). Essential/Critical AttributesAccording to Cheng, Foster & Huang, (2003) the critical attributes of pain include: (a) unpleasant and distressful experiences originating from physical sensation and having both positive and negative meanings for an individual; (b) an individual human experience; (c) a state of feeling in both sensation and emotion (verbal), and behavioral components; (d) physical and psychological responses to the stimulus; (e) function of pain, including protective and warning signs; (f) pain responses are learned and influenced by personality, environment, emotions, social and culture. Model Case Mrs.K is a 37 year old female with recent diagnosis of breast cancer. She has recently undergone a mastectomy and is now in the hospital for recovery. Upon the nurses’ hourly rounds she discovered Mrs. K crying, when asked what the nurse could do to help she stated that â€Å"I am in pain and can’t believe that I only have one breast now, I’m ugly and would have never thought it would hurt thi s bad†. The nurse consoled her and brought pain meds. When returning the patient thanked the nurse for the talk and she stated that the pain had eased and she always thought she would have breast cancer due to both her mom and grandmother having it.Related Case Mrs. T is a 35 year old female with breast soreness and discharge. She was found to only have fibroid tissue and nothing metastatic in her breast, but due to family history she elected to have bilateral mastectomies. She was ordered a PCA pump due to hourly pain calls and when the nurse entered the room she was crying c/o continuous pain. She states â€Å"I can’t take this pain and I hate I did this†. The nurse took time to talk with the patient and informed the physician of her crying and got new orders.During the nurses hourly rounds she found her sitting up on the phone and she explained to the nurse that she feels better and glad that she had the surgery because she did not want to go through what her mother and grandmother went through with breast cancer. Contrary Case Mr. M is a 45 year old that had a motor vehicle accident when he was 20 and is now going from hospital to hospital to try to get IV pain medication. He complains of back pain but x-ray results does not show any back issues but due to out of control behavior he is admitted and given pain medication. He refuses all by mouth pain meds and demands IV meds.He does not show any signs of pain when assessed and all staff believes him to be addicted to pain medication. A psych consult is ordered. This patient is not in true pain but has psychiatric issues. Antecedents and Consequences For this particular concept the antecedents and consequences would be all interrelated due to the fact that in nursing, medicine, and physical therapy the same factors apply for pain. Environmental, personal and cultural values act as antecedents related to the concept of pain. The consequences of pain are related to pain reaction and the ind ividual's own interpretation of the meaning of pain.Pain reaction has a more physical and biological focus; coping with pain refers to the perception of pain and is psychologically focused (Cheng, Foster ; Huang, 2003). When thinking of environmental, personal, and cultural values you begin to think of things such as the patients comorbidities, what the patient perceives as pain, and in their culture how is pain thought of. In many cultures it may be thought of that you must tolerate pain as long as you can while in other cultures their pain threshold is low so any uncomfortable feeling renders a pain medication.Consequences ultimately come from the patient themselves, what is perceived as pain and their history of pain. For example, a patient that has had a laminectomy may think because the pain was horrific the first time that it will be the same the next time, expecting the same relief factors even if the pain is not the same. Empirical Referents Empirical Referents are stated as what it used to measure the concept. Pain is very subjective and they have yet to invent an objective test that will give you the accuracy of some ones pain. They are measured by a scaling system.Most scales make pain measurable, and can tell providers whether your pain is mild, moderate or severe. They can also set baselines and trends for your pain, making it easier to find appropriate treatments. This includes the Numerical Rating scale asking for a pain rating on a scale of 1-10, the Wong-Baker scale which will include facial expressions to emphasize pain, or the Verbal-rating scale and in this scale the patient must complete a questionnaire to describe their pain in more detail (Jacques, 2010). Implications in Nursing In nursing pain is a major factor in treating the patient as it relates to the overall hospitalization.How are we able to get the blood pressure down if the patient is in constant pain? or how can I discharge a patient when they are in a lot of pain? Implications in nursing goes for all aspects of nursing from skin integrity to normal ADL’s. A patient may not turn as they should because they are in the fetal position due to pain which could cause skin issues or pain will cause them not to take a bath as usual. Pain can even cause depression as it decreases normal functioning. This concept is very important in the nursing field and should be treated and assessed appropriately.Conclusion In conclusion I chose to analyze pain as it relates to nursing, medicine, and physical therapy. It is a major factor in that it is related to all aspects of care that is received by these disciplines. Pain is the main contributing factor that causes someone to seek medical attention. Without pain we could have serious issues being that we would not know when were sick, burned, or injured. Pain is very important in healthcare and applies to nursing, medicine, and physical therapy. References Desai, G. , ; Chaturvedi, S. (2012). Pain with no cause! urses ' perception. Indian Journal of Palliative Care, 18(3), 162. Retrieved from http://www. medknow. com Hsiao, J. L. , Wu, W. C. , & Chen , R. F. (2013). Factors of accepting pain management decision support systems by nurse anesthetists. BMC Medical Informatics and Decision Making, 13, 16. Retrieved from http://www. biomedcentral. com/bmcmedinformdecismak/ (n. d. ). Pain. Med Plus Trusted Information for You, Retrieved from http://www. nlm. nih. gov/medlineplus/pain. html Walker, L. & Avant, K. (2005). Strategies for theory construction in nursing (4th ed. ).Upper Saddle River, NJ: Prentice Wells, N. , Pasero, C. , & McCaffery, M. (2008). Improving the quality of care through pain assessment and management. Patient Safety and Quality: An evidence based handbook for nursing, Retrieved from http://www. ncbi. nlm. nih. gov/books/NBK2658/ (2007). Guidelines for prescribing controlled substances for pain. Medical Board of California, Retrieved from http://www. mbc. ca. gov/pain_guidelines. html Wood, S. (2010). Post operative pain 1: Understanding the factors affecting patients’ experiences of pain. Retrieved from http://www. nursingtimes. et/nursing-practice/clinical-zones/pain-management/post-operative-pain-1-understanding-the-factors-affecting-patients-experiences-of-pain/5021696. article (1998). Physical therapy for chronic pain. 6(3), Retrieved from www. iasp-pain. org/AM/TemplateRedirect. cfm? template=/CM/†¦ Cheng, S. , Foster, R. , & Huang, C. (2003). Concept analysis of pain. Retrieved from www. tzuchi. com. tw/file/DivIntro/nursing/content/92-3/3. Jacques, E. (2010). Using pain scales to effectively communicate pain intensity. Can you rate your pain? , Retrieved from http://pain. about. com/od/testingdiagnosis/a/pain_scales. htm

Case Study: Osteoarthritis with a Total Knee Arthroplasty Essay

DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future due to his active lifestyle as a dairy farmer. DN is presently in very good health despite his pain from osteoarthritis. Osteoarthritis is caused from wear and tear on the joints. The bones between a joint is cushioned by cartilage which after many years of use decreases. When the bones no longer have the cushion, pain and stiffness develops when the bones rub together (Total Knee Replacement, 2009). His health history includes overcoming prostate cancer approximately six years ago. After a prostatectomy to remove his cancer, DN continues to experience erectile dysfunction even after seeing many specialists and trying many treatment options. In 1999, DN had his appendix removed at Ozark Medical Center. DN has a herniorrhaphy and cataract surgery prior to this hospitalization. DN has no known allergies to drugs, food, or environmental allergens. The patient lives at home with his wife on a dairy farm. He handles about 170 head of dairy cattle that are milked twice a day. He retired from Howell-Oregon County Electrical approximately five years ago to help manage his farm on a full time basis. DN and his wife raised three children and have several grandchildren who come and visit frequently. DN does not have any significant history of nicotine, alcohol, or drug use. His diet has consisted of fresh fruits and vegetables from the garden throughout his life. These factors have all played a part in helping DN stay healthy without any underlying chronic disease processe s. Physical Assessment My physical assessment was performed on September 16, 2009. DN’s vital signs consisted of an apical pulse of 98, a respiration rate of 20, a temperature of 99.1 degrees Fahrenheit, an oxygen saturation of 96%, a lying blood pressure of 117/78, a sitting blood pressure of 116/75, and a standing blood pressure of 116/74. Patient was alert and oriented to person, place, time, and situation. Patient was able to spell WORLD forward and backwards. PERLA and noted cardinal field of gaze were intact. Eyes were clear with conjunctiva pink and no discharge noted. Patient’s head and face was symmetrical with no apparent skin breakdown. Patient had dentures intact in mouth with healthy, pink gums with no lesions present inside the mouth. Thorax was symmetrical with no signs of pulsations or lesions. Breath sounds clear in all lobes. Unlabored breaths. Heart sounds S1, S2 were heard upon auscultation in all four cardiac areas with normal rhythm. Abdomen is soft, symmetrical with hyp oactive bowel sounds present in all four quadrants. Last bowel movement was on Sunday, September 13. Patient was passing flatus. No masses, distention, or lesions noted on the abdomen. No tenderness was noted in the abdomen. No edema was noted in the upper or lower extremities. Upper and lower extremities had no sign of lesions or discoloration. Saline locked on left forearm was intact with no redness or swelling. Surgical incision on lower left extremity had scant amounts of serosanguineous drainage, wound edges were well-approximated, slight erythemateous around incision, no odor present, and dressing was dry and intact. Pulses were strong and equal bilaterally- including carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibialis. Skin was warm and pink with no signs of cyanosis, rash, or skin breakdown. Gait was symmetrical and coordinated when using a walker, without the supportive device there is some unsteadiness due to the left total knee arthroplasty. There was no hearing deficit noted with normal conversation. Patient only had complaints of pain at surgical site after ambula tion, physical therapy or the CPM. Patient was taught he could ask for the pain medicine prior to these events to hopefully avoid intense pain. Current Medications Throughout DN’s hospital stay he was prescribed medicine to alleviate the pain caused from the total knee arthroplasty, help prevent any infection that had potential to be a problem, and prevent any complications. DN’s urrent medications while in the hospital were as follows: 1.) Docusate-Senna (Trade Name: Peri-Colace) 1 tablet by mouth, twice a day; used for softening and passage of stool for the relief of constipation caused by post operative anesthesia and decreased activity (Deglin & Vallerand, 2007). 2.) Enoxaparin (Trade Name: Lovenox) 40 mg by subcutaneous injection, once every morning; used for the prevention of thrombosis formation (Deglin & Vallerand, 2007). 3.) Psyllium (Trade Name: Metamucil) 1 tablespoon by mouth, twice a day; used for relief and prevention of constipation (Deglin & Vallerand, 2007). 4.) Acetaminophen-Oxycodone (Trade Name: Percocet 5/325) 1-2 tablets by mouth, every four hours; used for decreasing pain as well as decreasing a temperature (Deglin & Vallerand, 2007). 5.) Magnesium Hydroxide (Trade Name: Milk of Magnesia) 30 mL by mouth as needed; used for replacement in a deficient state or evacuation of the colon (Deglin & Vallerand, 2007). 6.) Morphine (Trade Name: Astramorph) 8 mg by intravenous piggyback, every three hours as needed; used for a decrease in the severity of pain (Deglin & Vallerand, 2007). 7.) Promethazine (Trade Name: Phenergan) 12.5 mg by intravenous piggyback, every four hours as needed; used for diminishing nausea and vomiting, as well as provide some sedation (Deglin & Vallerand, 2007). Diagnostic Tests DN had diagnostic tests prior to being admitted to the hospital for his total knee arthroplasty to determine the best treatment option for his osteoarthritis. After his surgery, more diagnostic tests were done to monitor for complications of the procedure. The results were compared to normal and were as follows for the patient: 1.) White Blood Cells (Normal Value: 5,000-10,000/mm3) Patient’s white blood cell count was 12,800/mm3, which is a high value. This value indicates the stress on the body and inflammation around the knee involved after the operation. The value is also a possible indicator of infection, which would require continued monitoring (Pagana & Pagana, 2006). 2.) Red Blood Cell Count (Normal Value: 4.7-6.1Ãâ€"106/ µl) Patient’s red blood cell count was 3.74Ãâ€"106/ µl, which is a low value. This value indicates the blood lost during surgery, which is a common finding after an invasive surgery. A decreased level may indicate a hemorrhage, overhydration, or a dietary deficiency, which may need to be corrected (Pagana & Pagana, 2006). 3.) Hemoglobin (Normal Value: 14-18 g/dL) Patient’s hemoglobin was 11.8 g/dL, which is a low value. This value is a common finding after surgery due to the blood loss, but the value may also indicate anemia or nutritional deficiency (Pagana & Pagana, 2006). 4.) Hematocrit (Normal Value: 42-52%) Patient’s hematocrit was 34.4%, which is a low value. This is a normal finding after surgery, but may indicate anemia, malnutrition, or a dietary deficiency that may need to be corrected (Pagana & Pagana, 2006). 5.) Mean Corpuscular Hemoglobin (Normal Value: 27-31 pg) Patient’s mean corpuscular hemoglobin was 31.8 pg, which is just slightly elevated. This value could possibly indicate a macrocytic anemia, but is not elevated enough to be a significant concern (Pagana & Pagana, 2006). Basic Conditioning Factors and Power Components Dorthea Orem identifies ten basic conditioning factors that identify the patient and help assess the need for care in her Self-Care Deficit Theory of Nursing. The basic conditioning factors identified by Orem consist of age, gender, Erikson’s developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and availability of resources (Caton, 2008). DN is a 68 year old Caucasian male who lives in Pomona, Missouri where he and his wife own a house. DN grew up in Dora, Missouri where he graduated high school, then relocated to Pomona at the age of nineteen. DN has three grown children and several grandchildren. DN’s family remains very close and visit often to where DN lives. DN quit his job at Howell-Oregon Electric in 1980 to become a full time farmer. DN and his wife own approximately 300 acres to operate a dairy and beef cattle farm with 170 head of cattle. They milk the cows twice a day keeping them very active throughout the day. DN considers himself to be in the middle-class economically, but with the unpredictable cattle market economic status can change throughout the year. DN has Medicare as primary insurance with supplements. Before his admission to the hospital, DN’s health state was good. DN’s health care system factors consist of a medical diagnosis of osteoarthritis. The treatment of choice for DN was a left total knee replacement. After discharge, home health will help organize physical therapy closer to home. DN does not have any underlying diseases, such as hypertension or diabetes, which can cause complications or alter the ability of DN to have a speedy recovery. He has a primary physician in Willow Springs for yearly check-ups and minor problems. DN’s patterns of living include hunting and fishing, going to church, and taking care of the farm. DN does not smoke or drink alcohol. According to Erikson, he is in a developmental stage of ego integrity versus despair (Berman et al., 2007). DN belongs in this psychosocial developmental stage because he is at a stage where he is content with his life and satisfied with everything that has happened in his life thus far. He is able to reflect on his past without regret. DN feels as if he has lived a life full of happiness. Orem identifies ten power components that are important in evaluating how much nursing care is needed by the patient. The ten power components consist of attention span and vigilance, control of physical energy, control of body movements, ability to reason, motivation for action, decision making skills, knowledge, repertoire of skills, ability to order self-care actions, and ability to integrate self-care actions into patterns of living (Caton, 2008). DN’s attention span ad vigilance is a strength because throughout the physical assessment and health history, he remained very attentive and honest when answering the questions. His control of physical energy is a potential weakness due to the fatigue DN could experience after his knee replacement. After surgery, becoming fatigued is easier due to the pain and inability to get a good night’s rest in the hospital. DN seemed to know his limits with what kind of physical energy he had to use throughout his stay. The patient’s control of body movements is a strength. Even though DN is recovering from a total knee replacement, he maintains good control over his movements. He also has a steady gait when walking with a supportive device. The patient’s ability to reason is a strength. When he needed help, he knew to ask his wife, a nurse, or an aide for help. He understood that Home Health would be a benefit once he was discharged from the hospital. Motivation for action is definitely a strength. DN was very motivated to get back on his feet as soon as he could. He knew physical therapy was what would help the most so he was always ready to go when physical therapy came to take him to the Joint Club. After returning after a trip to physical therapy, the patient stated, â€Å"The physical therapist said I did better than all of the other patients with knee replacements.† The patient’s decision making skills were strength because he took all options into consideration prior to getting his knee replacement. He knew it would be the best option with the active lifestyle that he has. Knowledge was a potential deficit for the patient because he had never had a knee replacement surgery before. The patient was informed of all the procedures, hospital stay, and expected outcomes during consultation appointments, but all the information at once can be overwhelming for the patient. Even after the surgery, the patient still questioned the health care team members throughout the hospital stay to refresh his memory. Repertoire of skills is a strength because the patient has a high school education, as well as the same occupation throughout his life. He is able to retain information and repeat skills if needed. DN’s ability to order self-care actions is a strength because he is able to decide what actions are most important and follow through with them. He decided to have his knee surgery to benefit his lifestyle and made it a priority to get it done as soon as he could. The ability to integrate self-care actions into his patterns of living is a strength for DN. He integrates a healthy diet and active lifestyle to prevent complications of his osteoarthritis. After trying minor treatment options to control pain and discomfort from the osteoarthritis, DN opted for surgical treatment and he realizes the physical therapy he will have to integrate into his lifestyle for full recovery. Universal Self-Care Requisites Orem’s General Theory of Nursing involves self-care, self-care deficit, and nursing systems. Orem’s definition of self-care is what people plan and do on their own behalf to maintain life, health, and wellness. The nursing systems that Orem identifies are wholly compensatory, partly compensatory, and supportive-educative. The universal self-care requisites that patient may be deficient, potentially deficient, or a strength in consists of air, water, food, elimination, activity and rest, solitude and social interaction, prevention of hazards to human life, and normalcy (Berman et al., 2007). Air: Potential Deficit Air is a potential deficit for this patient. Upon assessment, his respiratory rate was within normal range at 20 breaths per minute. Normal respirations for the age group of the client range from fifteen to twenty per minute (Berman et al., 2007). The patient has a stable respiration rate between this level, but with decrease red blood cells, hemoglobin, and hematocrit the patient’s oxygen level may increase to compensate for the lack of cells that can carry the oxygen, especially during physical therapy. DN’s lung sounds when auscultated were clear in all lobes, bilaterally. A critical side effect of morphine, one of the medications DN was taking while in the hospital, is respiratory depression, which can happen in a matter of minutes causing a deficit (Deglin & Vallerand, 2007). Water: Strength Water is a strength for DN. No edema was noted upon assessment. Good skin turgor was indicative that there was adequate hydration for the patient. DN’s average intake was 2000 mL of fluids, usually water and ice tea. This was within normal range with the requirements being set at a minimum of 1500 mL of fluids daily (Berman et al., 2007). Food: Strength Food is a strength for the patient. The patient was on a regular diet and had no trouble eating. On some occasions, his wife brought meals to the patient. DN consumes a healthy diet, full of fruits and vegetables from his own garden when home. Protein consumed in his diet usually consists of very lean beef from home grown cattle. DN consumed enough calories to aid in recovery of his surgery. Elimination: Deficit Elimination is a problem for the patient. He has not had a bowel movement since the day before he had the surgery. DN had an epidural anesthesia until the first day post-op and is taking narcotic analgesics for pain control, which both contributed to the impaired elimination. The side effects from the medication cause the intestines to decrease peristalsis. Monitoring bowel functions, as well as administer the stool softeners and laxatives that are ordered, are two important nursing interventions (Lemone & Burke, 2008). Activity and Rest: Deficit The patient had a deficit in both activity and rest. The patient stated he was not getting adequate rest in the hospital due to the different environment and the pain he was experiencing from his surgery. In the hospital, the patient was also put on activity restrictions due to his total knee arthroplasty. He was able to go to physical therapy three times a day, but normal activities were limited for DN. At home DN does not have activity or rest deficit, he participates in an active lifestyle with lots of walking and daily physical labor. He also gets approximately 7 or 8 hours of sleep a night which is adequate for a man his age (Berman et al., 2007). Solitude and Social Interaction: Potential Deficit The patient did not have a deficit with social interaction. His wife was in the room majority of the time and he also had many people drop in and see him throughout his hospital stay. DN also interacted with people on the health care team, whether it was the nurses or physical therapists, he was always having a conversation with someone. Due the many visitors and activities DN had during the day, solitude was a potential deficit. The physical therapists and nurses that came in the room consistently make it difficult for the patient to get any time to rest and relax by himself. Adequate rest is easier to obtain when there are no interruptions in the rest period and some solitude is allowed. Hazard Prevention: Deficit Hazard prevention is a deficit for DN. The total knee arthroplasty causes the patient to be at an increased risk for infection due to all the invasive procedures done. Prophylactic antibiotics were being considered to help prevent any infection that may develop. The patient is also at risk for falls. The intravenous line and pole make it difficult for the patient to ambulate on his own while dealing with his surgery. The medications DN were taking could cause confusion, dizziness, and sedation which could lead to a fall. The patient is also at risk for a deep vein thrombus due to the surgery, which could be a fatal complication if not prevented. Compression stockings and devices were used to decrease the chance of venous stasis. Promotion of Normality: Deficit Promotion of normality is a deficit for the patient. He has only been hospitalized two other times in his life and feels uncomfortable. Since DN is not used to being in the hospital, he is hesitant to ask for pain medication until the pain is already present. Teaching DN to ask for the pain medicine prior to activities and when he recognizes the pain coming back. DN’s normal routine at home will be changed to accommodate for the knee surgery he underwent. He will have to adjust to the limitations on his activities until he is fully recovered. For example, he will have to depend on his wife and other family members to help milk the cows and take care of the farm until he has full range of movement so he does not damage his newly replaced knee. Developmental Self-Care Requisites Developmental self-care requisites are associated with conditions that result in maturation (Berman et al., 2007). DN has lived a long, productive life and many life changing events have occurred throughout his life. He graduated high school and worked multiple jobs which gave him the experience he needed to now be a self-employed farmer. He and his wife raised a family with three children, and now have several grandchildren. All of these different aspects in DN life have helped DN mature, which puts him in a developmental stage of ego integrity versus despair. According to Erikson, people in this stage should have acceptance of their life and self-worth (Berman et al., 2007). DN seems very satisfied with everything that has happened in his life. He is able to reminisce about the things that have happened in his life with a smile. He does not have any regrets about his life. At this point in DN’s life, he is always thinking of others and enjoying the small things in life. Even though DN is in this developmental stage, he has not fully completed this stage. DN is in a position where he still works and provides for his family. He is not ready to leave his family at this point in his life. Health Deviation Self-Care Requisites According to Orem, there are six health deviation self-care requisites. The health care deviation self-care requisites consist of seeking and securing medical help when needed, responsibly attending to the effects and results of pathologic conditions, effectively carrying out prescribed interventions, responsibly attending to the regulation of effects resulting from prescribed interventions, accepting the fact that sometimes self or others need medical help when faced with certain life challenges, and learning to live productively with the effects of pathologic conditions and treatments while promoting continued personal development (Caton, 2007). The patient is strong in seeking and securing medical help when needed. As soon as the patient realized his pain was increasing in his knee, he scheduled an appointment with his family doctor who referred him to Dr. Know the orthopedic surgeon. The patient is also responsible in attending to the effects and results of pathologic conditions. The patient is aware of the physical therapy regime he needs to complete for full recovery, as well as the preventive measures he needs to take to protect his right knee. The third health deviation self-care requisite is to effectively carry out prescribed interventions, which is a strength for the patient. DN realizes he will continue with physical therapy after discharge on the hospital and will be on a few prescription medications. Other interventions, such as wearing TED hoses, limiting activities, and allowing home health to help with his care, will all be followed by the patient. The fourth health deviation self-care requisite is to responsibly attend to the regulation of effects resulting from prescribed interventions is a potential deficit. Even though the patient stated he will do the interventions asked of him, the task of depending on others for help may be difficult. As a farmer, it is difficult to let someone else do the chores the patient is usually doing on a daily basis. The fifth health deviation self-care requisite is accepting the fact that sometimes self or others need medical help when faced with certain life challenges. This health deviation self-care requisite is a strength for the patient. When DN realized his knee was not functioning at the level he needed it too, he sought help from professionals after trying alternative treatments. When DN had his prostate removed due to prostate cancer, he also pursued help from many specialists to deal with the many complications a prostatectomy can cause. The sixth health deviation self-care requisite is learning to live productively with the effects of pathologic conditions and treatments while promoting continued personal development. This is a strength for the DN because he looks forward to having better function in his knee to live a more productive life. The chores he does on the farm were becoming difficult with the increasing pain in his knee prior to the surgery. The patient now talks enthusiastically about getting back out on the farm to do the things he loves to do. Nursing Diagnosis I. Nursing Diagnosis #1: Acute Pain related to tissue trauma caused by surgery and intense physical therapy regime as evidenced by patient verbalizing his pain an 8 on a 1-10 scale. a. Expected Outcome: Patient verbalizes relief of pain as less than a 3 on a 1-10 scale at least thirty minutes after administration of pain medication. i. Intervention #1: Assess the patient’s description of pain and effectiveness of pain-relieving interventions. 1. Rationale: Assessing pain description leads to the best interventions to control the pain, as well as assess for any complications with a different pain description. Every patient has a right to effective pain relief (Gulanick & Vallerand, 2007). ii. Intervention #2: Instruct the patient to request pain medication before the pain becomes severe. 2. Rationale: Relief will take longer if the patient waits until the pain is too severe (Gulanick & Vallerand, 2007). The best pain control is proactive, not reactive. iii. Intervention #3: Administer narcotic analgesics as ordered by the doctor. 3. Rationale: With all of the tissue damage done during surgery, the nurse should assume the patient is in pain and needs analgesics (Gulanick & Vallerand, 2007). a. Implementation/Evaluation: Nurse assessed the patient’s description of pain to adequately treat the pain symptoms. Nurse taught the patient the request the pain medication at the onset of pain to reduce the amount of time it takes to start working. The goal was met because the patient verbalized his pain less than a 3 on a 1-10 scale within 30 minutes of administration of pain medication. b. Expected Outcome: Patient appears comfortable as evidenced by absence of facial grimacing and use of stress management techniques between doses of pain medication and throughout hospital stay. iv. Intervention #1: Nurse will teach patient to use guided imagery and progressive relaxation. 4. Rationale : Use of guided imagery and progressive relaxation will distract patient from the pain he is experiencing (Gulanick & Vallerand, 2007). v. Intervention #2: Nurse will teach patient to change position frequently. 5. Rationale: Changing positions (within limits) will relieve pressure and pain on bony prominences, reduce muscle spasm, and undue tension (Gulanick & Vallerand, 2007). vi. Intervention #3: Nurse will apply ice packs as ordered. 6. Rationale: Applying ice packs may decrease edema and enhance comfort (Gulanick & Vallerand, 2007). b. Implementation/Evaluation: Nurse taught the patient different comfort measure to relieve pain in between doses of pain medication. Using repositioning and relaxation measures helped the patient stay comfortable between doses of pain medication. The goal was met. II. Nursing Diagnosis #2: Impaired physical mobility related to pain after surgical procedure as evidenced by limited ability to ambulate. c. Expected Outcome: Patient will maintain optimal mobility within limitations throughout hospital stay. vii. Intervention #1: Assess postoperative range of motion in affected and unaffected joints. 7. Rationale: Assessment of range of motion will give a baseline to see if the patient is improving. Range of motion exercises are important to strengthen affected joint (within limitations) and unaffected joints need to maintain current mobility in periods of decreased activity because joints with arthritis lose function more rapidly (Gulanick & Vallerand, 2007). viii. Intervention #2: Nurse will assist patient to ambulate with less assistance as tolerated. 8. Rationale: This will allow for patient to become more independent before discharge (Gulanick & Vallerand, 2007). ix. Intervention #3: Nurse will encourage the patient to move from the bed to the chair as tolerated, as well as ambulate in the room three times a day. 9. Progress will be monitored toward normal activities patient will do once discharged from the hospital (Gulanick & Vallerand, 2007). c. Implementation/Evaluation: Nurse assessed postoperative range of motion to have a baseline of function. Improvement was noted th roughout shift that the patient was able to move more independently. d. Expected Outcome: Patient participates in rehabilitation program throughout hospital stay. x. Intervention #1: Assess the patient’s fear or anxiety in ambulating and going to physical therapy. 10. Rationale: If the patient’s fear and anxiety is too great, the patient may not get the full benefit of physical therapy and is at a greater risk for falls or other injuries (Gulanick & Vallerand, 2007). xi. Intervention #2: Nurse will encourage use of supportive walking devices, such as a walker. 11. Rationale: Use of a walker will help the patient feel more independent and encouraged to go to physical therapy as ordered. More weight bearing will progress throughout the use of walker (Gulanick & Vallerand, 2007). xii. Intervention #3: Nurse will reinforce instructions for rehabilitative activities as ordered. 12. Rationale: Reinforcing instructions will help the patient achieve mobility throughout the hospital stay and adhere to the physical therapy program (Gulanick & Vallerand, 2007). d. Implementation/Evaluation: The patient was enthusiastic about physical therapy and gaining full mobility of affected leg. He participated in the rehabilitation program and was able to go home on schedule, so the goal was met. III. Nursing Diagnosis #3: Self-care deficit related to impaired mobility as evidenced by inability to perform activities of daily living, such as dressing, bathing, and ambulate independently. e. Expected Outcome #1: Patient will safely perform all self-care activities of daily living independently before discharge. xiii. Intervention #1: Nurse will assess the patient’s ability to perform activities of daily living. 13. Rationale: This will provide a baseline to know where the priority deficits in the patient’s performance of ADLs and help nurse assist with the patient’s needs (Gulanick & Vallerand, 2007). xiv. Intervention #2: Assist the patient in accepting help from others. 14. Rationale: The patient may need to realize after a total knee replacement, some assistance may be needed and dependence on people or supportive devices may be necessary temporarily (Gulanick & Vallerand, 2007). xv. Intervention #3: Nurse will implement measures to facilitate independen ce, but be available to help patient when needed. 15. Rationale: Giving the patient independence will help encourage patient to attempt ADLs on his own, but with assistance when needed will prevent falls or other injuries (Gulanick & Vallerand, 2007). e. Implementation/Evaluation: Nurse assessed the patient’s ability to perform activities of daily living and realized where the patient needed assistance. Patient was encouraged to do ADLs on his own, but to recognize and ask for help if he needed it. Patient was able to ambulate on his own the bathroom, perform most activities independently, but required some help from his wife by discharge. This goal was met because the patient realized when he needed help and performed all ADLs safely by discharge. f. Expected Outcome #2: Resources are identified that are useful in optimizing the autonomy and independence of the patient by discharge from the hospital. xvi. Intervention #1: Nurse will assess what assistance will be needed when the patient is discharged. 16. Rationale: This will be helpful to the patient and other caregivers to recognize deficits until they are overcome (Gulanick & Vallerand, 2007). xvii. Intervention #2: Nurse will encourage patient to use assistive devices until no longer needed, and reassure patient that use of them can prevent falls and injuries. 17. Rationale: This allows patient to know total independence is not expected just because the patient is being discharged (Gulanick & Vallerand, 2007). xviii. Intervention #3: Nurse will help the patient set short term goals to becoming more independent. 18. Rationale: Setting short term goals will decrease the frustration the patient may have in not being able to do activities he could do before surgery (Gulanick & Vallerand, 2007). f. Implementation/Evaluation: Nurse assessed what assistance may be needed to help with activities of daily living. Patient used assistive devices and help from others when he recognized he could not do them independently. Short term goals were set and patient was able to be discharged with a walker and home health services. This expected outcome was met. IV. Nursing Diagnosis #4: Risk for ineffective tissue perfusion related to surgical procedure and impaired physical mobility. g. Expected Outcome: Patient maintains adequate tissue perfusion and remains free from deep vein thrombosis, as evidenced by warm extremities, good capillary refill, bilaterally equal pulses, negative Homan’s sign, and stable vital signs. xix. Intervention #1: Assess neurovascular status of affected limb preoperatively and postoperatively, as well as assess for signs and symptoms of deep vein thrombosis. 19. Rationale: Preoperatively a baseline should be established and assessing for changes postoperatively will be indication of a problem. Signs and symptoms could be an early indication of a blood clot which leads to early intervention (Gulanick & Vallerand, 2007). xx. Intervention #2: Nurse will assist patient in using thromboembolic disease support hoses and sequential compression devices as prescribed. 20. Antiembolic devices, such as TED hose and SC Ds, increase venous blood flow to the heart and decrease venous stasis, which could prevent a blood clot (Gulanick & Vallerand, 2007). xxi. Intervention #3: Nurse will administer thrombolytic and anticoagulant agents as ordered. 21. Rationale: Prophylactic anticoagulants will reduce the risk of deep vein thrombosis and thrombolytic drugs may decrease the complications if a blood clot does develop (Gulanick & Vallerand, 2007). g. Implementation/Evaluation: Patient was assessed preoperatively and postoperatively for neurovascular status. Patient was monitored closely for any signs of ineffective tissue perfusion. Nurse encouraged use of antiembolic devices and patient adhered to regimen. The goal was met because ineffective tissue perfusion was not a problem and not deep vein thrombosis developed. V. Nursing Diagnosis #5: Deficient knowledge related to a new procedure and unfamiliar with the discharge plan as evidenced by patient questioning health care team members about the process. h. Expected Outcome: Patient verbalizes understanding of procedure and discharge instructions. xxii. Intervention #1: Assess the patient’s current understanding of process in hospital and discharge instructions. 22. This will allow the nurse the individualize the teaching plan for the patient and teach only what the patient does not understand (Gulanick & Vallerand, 2007). xxiii. Intervention #2: Nurse will review total knee arthroplasty precautions according to what the patient does not already know, for example, using the walker, maintain proper body weight, and when to notify the physician. 23. Rationale: Reviewing the information will reinforce adherence to the rehabilitation program (Gulanick & Vallerand, 2007). xxiv. Intervention #3: Nurse will explain the discharge follow up instructions, and reinforce the need to continue with home health for physical therapy. 24. Rationale: Home health and physical therapy will increase the patient’s strength to have a full recovery. When the patient understands the process, he will be more motivated to continue with the program (Gulanick & Vallerand, 2007). h. Implementation/Evaluation: This goal was met. The patient had a full understanding of the limitations of a knee arthroplasty, in the hospital and after discharge. He understood the follow-up appointments and how home health would assist in his recovery. VI. Nursing Diagnosis #6: Constipation related to inactivity and medication use as evidenced by patient having frequent but nonproductive desire to defecate. VII. Nursing Diagnosis #7: Risk for infection related to invasive procedure. VIII. Nursing Diagnosis #8: Risk for falls related to unsteady gait and pain in left leg. References Berman, A., Snyder, S., Kozier, B., & Erb, G. (2007). Fundamentals of nursing: Concepts, process, and practice (8th ed.). Upper Saddle Road, NJ: Pearson. Caton, B. (2007). Orem’s self care requistes. Handout for NUR100 Fundamentals of Nursing. Missouri State University-West Plains, Fall 2007. Deglin, J.H., & Vallerand, A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia: F.A. Davis. Gulanick, M., & Myers, J.L. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis: MO: Elsevier. LeMone, P., & Burke, K.M. (2004). Medical-surgical nursing: Critical thinking in client care (3rd Ed.). Upper Saddle Road, NJ: Pearson. Pagana, K.D., & Pagana, T.J. (2006). Mosby’s manual of diagnostic and laboratory tests (3rd ed.). St. Louis, MO: Mosby. Total Knee Replacement (2009). American Academy of Orthopaedic Surgeons. Retrieved October 19, 2009, from http://orthoinfo.aaos.org/topic.cfm?topic=A00389.

Own Self Concepts Essay

Own Self Concepts SPC 2300 – 12 Own Self Concepts 1. Define one change you would like to make in yourself. It might be a behavior or anything about yourself that you would like to alter. * I would like to change one of my behaviors about myself. The worst quality about me is that I am always late no matter what the case may be. I am not late on purpose, but it seems like something always puts me behind schedule. It drives both my family and friends crazy. They have learned when I say I will be there in thirty minutes, to expect me in about an hour. This is a behavior of mine that I need to work on immediately. . Write a specific goal for making the change, being sure your goal is realistic and fair. Use affirming, motivational language in your goal. For example, â€Å"I will show my best friends that I am paying attention when they talk to me. † * This is something about myself I have needed to change for a long time. It is not something I do intentionally to drive my f amily and friends crazy. I need to become a little more time oriented, so that I can be where I say I am going to be, at a certain time. I will show my family and friends that I can be on time to their events. My first goal is to sit down with a calendar, and write down already known events and times. This way I will not schedule more than one event at a time. Next, by having a planner, I can add any new events that occur in future. I will be able to check available dates and make sure I have nothing already planned. Lastly, by sticking to my schedule and planning ahead it should reduce the amount of time I am late. I know I always have to expect the unexpected, but at least I have control over the already known about. 3. Observe or think of others who are models for what you want to be. Write down what they do. For example, â€Å"Tracy nods a lot and repeats back what others say so they know she is listening. † * A model person for me to observe and take tips from would be my mother. She will have a whole list of things to accomplish within her day, and gets them all done and on time. She has a monthly day planner that she carries with her at all times. She always makes sure to add important and upcoming events, as well as any of her daily to-dos to the planner. My mom also makes sure not to make more plans than she can fulfill within her day. It seems to work for my mom, so I don’t see why it wouldn’t work for me. . What context or setting is required for you to achieve your goal? For example, â€Å"I will talk with my friends in private, distraction-free settings. † * I will need to follow the schedule I set for myself and not let myself get distracted from my original plans. It might even be good for my family and friends to be a little bit stricter when it co mes to my tardiness. For the most part, this behavior is something I have to train myself on. No one else can do this for me. I have got to learn how to manage my time better, so that I will arrive at events when I am supposed to be there. . Identify potential barriers to the change. Some potential barriers that may cause some problems for my change will be the exact people who request the change of me. I will admit that I do control a lot of my tardiness, but not all of it is my fault. I will be on my way somewhere, when a friend asks me to do something for them. They promise it will only take five minutes. At that point, it is usually over an hour when they are done with me. I have got to learn to tell my family and friends no sometimes, in order to fulfill prior obligations.

No Child Left Behind Act Research Paper Example | Topics and Well Written Essays - 250 words

No Child Left Behind Act - Research Paper Example The assessment of the basic skills of the students as well as national achievement standard is the highlight of the act. "No Child Left Behind (NCLB) emphasizes standardized testing to measure improvements in reading, math and the sciences. It consists of four general principles: teacher quality, student testing, scientifically based research and public school choice." (Background: No Child Left Behind). Therefore, the NCLB has been an essential step in elevating the performance of American schools and student with federal oversight and strict penalties for poor performance. The act sets standards by each individual state, rather than a national achievement standard and takes steps in improving the quality of education. According to the educational practitioners, the No Child Left Behind (NCLB) law has had a sweeping impact on U.S. public school classrooms. "It affects what students are taught, the tests they take, the training of their teachers and the way money is spent on educatio n." (What the No Child Left Behind Law Means for Your Child). In conclusion, the No Child Left Behind Law has been a fundamental development in the educational spectrum of the US and it aims at the overall improvement of the quality of education in the nation.