The Glasgow Coma Scale Health And Social Care Essay

The Glasgow Coma Scale Health And Social Care Essay There are three types of cord syndromes related to spinal cord injury. These are the central cord syndrome, anterior cord syndrome, and brown-sequard syndrome or the lateral cord syndrome. The central cord syndrome is caused by injury or edema in the central cord usualy in the cervical area due to hyperextension injuries. This results to motor weakness of the upper extremities than the lower extremities. The anterior cord syndrome is caused by disk herniation or compression of the artery that runs along the front of the spinal cord. This causes loss of sensory, loss of pain and temperature but sensitivity to position and vibrations are preserved. The brown-sequard syndrome or lateral cord syndrome may be a result of penetrating injury in the spine or hemisection of the cord. This causes ipsilateral hemiplegia with loss of touch, pressure and vibration also contralateral pain and temperature sensation deficits. Discuss how the Glasgow Coma Scale is utilized in determining neurological status. The Glasgow coma scale is used widely in hospitals to give a reliable, objective way of recoding the level of consciousness of a patient. The GCS has three elements, the eye response, verbal response and motor response. Each has their own grades. For the eye response 4pts for open spontaneously, 3pts to open to non-verbal command, 2pts on open in response to pain and 1pt to no response. For verbal response 5pts for talking/oriented, 4pts for confused speech/disoriented, 3pts on inappropriate words, 2pts for incomprehensible sounds and 1pt for no response. Last for motor response 6pts for obey commands, 5pts to localizes to pain, 4pts for flexion/ withdrawal from painful stimuli, 3pts to flexion in response to pain, 2pts for extension in response to pain and 1pt to no response. 15pts is the perfect score and 3 as the lowest score which indicates that the patient is in deep coma. Discuss nursing interventions related to prevention of injury in the brain-injured patient. To prevent injury for patient that has brain injury the patient must be assessed to ensure adequate oxygenation and that the bladder is not distended. Dressings and casts mast be check for constriction. The side rails must be raised and padded to avoid falling. The bed must also be lowered. Reducing environmental stimuli and to have an adequate lighting. Minimize disturbances during sleep to provide adequate rest for the patient. Medications can be given as prescribed to prevent restlessness. For incontinence catheter can be used. Written assignment Identify risk factors for spinal cord injury. Spinal cord injury is an injury due to an unexpected accident. In short everyone can have a spinal cord injury. Still there are some risk factors. One risk factor is if you are engage in active sports or into jobs that requires lifting heavy loads. Another risk factor is for the people who are in the 16-30yrs of age because in these years people are active and many people at these age bracket is now driving and one of the leading cause of spinal cord injury is vehicular accidents. And if you have bone disorder like osteoporosis, this can cause spinal cord injury. List three clinical features of the patient with neurogenic shock. Neurogenic shock is caused by injury in the central nervous system that causes vasodilation as a result of loss of balance between the sympathetic and parasympathetic stimulation. This causes low blood pressure (hypotension), decrease heart rate (bradycardia), and reduce venous return which gives a dry, warm skin. Why is autonomic dysreflexia an acute emergency situation? Autonomic dysreflexia is the over activity of the autonomic nervous system. The nerve impulses that are being send to the brain are blocked by a lesion in the spinal cord (at the t-5 level or above) which causes the brain to increase activity of the sympathetic system that results to a rise in blood pressure. The heart then sends impulse to the brain that causes the heart to slow down and the blood vessels above the spinal injury to dilate. But the brain cannot send impulse below the level of injury due to the lesion therefore blood pressure cannot be regulated. This is an acute emergency situation because if not treated immediately this may lead to seizures, stroke and even death. Develop a matrix identifying concussion, contusion, and diffuse axonal injury. Identify clinical manifestations and associated diagnostic testing. Definition Clinical manifestation Diagnostic testing Concussion Injury to the brain that is a result from an impact to the head. Ranges from mild to severe concussion Mild concussion Slightly dazed Brief loss of consciousness Severe concussion Longer loss of consciousness Longer recovery time Other manifestations Nausea and vomiting Blurred vision Confusion Fatigue Short-term memory loss Neurological function tests CT scan Contusion Traumatic brain injury or bruising of the brain because of sever acceleration-deceleration force or blunt trauma Loss of consciousness Lack of motor coordination Memory problems CT scan MRI Diffuse axonal injury This is a diffuse brain injury cause by severe head traumas. As tissue slides over tissue, a shearing injury occurs. This causes the lesions that are responsible for unconsciousness, as well as the vegetative state that occurs after a severe head injury Lack of consciousness No lucid interval Immediate coma MRI CT scan EEG electroencephalogram Discuss the long-term rehabilitation needs of the spinal cord injured patient. Within a group, ask questions regarding nursing care in the rehabilitative phase. For patients who suffered spinal cord injury rehabilitation is needed to restore as much function to the patient. The patient must understand his condition and reduce assistance with activities and let the patient be independent to improve motor function and also to increase the patients self-esteem. Discuss nursing management for the head-injured patient related to nursing applicable nursing diagnoses. Ineffective airway clearance Assess the respiratory status Check the patency of the airway Ensure airway clearance Ineffective tissue perfusion (cerebral) Assess the visual, sensory and motor functions Note for headache, dizziness, altered mental status and personality changes Elevate HOB (10 degrees) and maintain head/neck in midline or neutral position to promote circulation and venous drainage Decrease intracranial adaptive capability Monitor patients neurological vital signs (GCS) Monitor ICP Assess the patients reflexes Decrease environmental stimuli Risk for injury Provide safe environment Raise side rails Lower bed Web output NURSING MANAGEMENT OF ADULTS WITH SEVERE TRAUMATIC BRAIN INJURY http://www.dvbic.org/images/pdfs/AANN08_TBIGuide_2-13-09_update.aspx Base on the study that I have read, the neuroscience nurse is the one who intervenes to maintain and manage intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patience with traumatic brain injury (TBI). The prevention of complications commonly associated with TBI is also involved in the management of care for TBI patients such as deep vein thrombosis (DVT), hyperglycemia, and excessive protein loss. In maintaining or decreasing of ICP, this study recommended guidelines. First, an uncontrolled intracranial hypertension leads to an absence of cerebral perfusion and results in brain death thus, the recommended ICP according to the original Guidelines for the Management of Severe head Injury should be at less than 20mmHg (Bullock, Chestnut, Clifton, 1995), as stated in the study. Second, the draining of cerebrospinal fluid (CSF) -this decreases ICP. As stated in the study, according to the Brain Trauma Foundation, American Association of Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care (2000), the first step to reduce intracranial hypertension is through ventricular drainage. As early as 1960, Lund demonstrated that removal of CSF via ventriculostomy temporarily decreases ICP (Lund, 1960). Draining as little as 3ml of CSF was found to decrease ICP by 10.1% relative to the baseline value of 10 minutes in 58 patients with severe TBI (Kerr, Weber, Sereika, Wi lberger, Marion, 2001). Protocols for CSF diversion range from time- dependent (leave drainage open for 5 minutes, then close), CSF-volume-dependent (drain 5cc then close), to continuous drainage (open all the time, closed at intervals to obtain an accurate ICP reading). This is supported by Monroe- Kellie hypothesis stating that a normal ICP can be maintained as one component in the cranial compartment (brain, blood and CSF) increases as long as there is a corresponding decrease of another component- therefore, decrease of one component decreases ICP. Third is not inducing hyperventilation to decrease ICP. Hyperventilation was routinely used to manage severe TBI. Studies done in the 1990s demonstrated the vasoconstriction associated with hyperventilation also resulted in decrease cerebral blood flow (CBF), thus, it is recommended to maintain normocapnia in most patients with severe TBI (Brain Trauma Foundation et al., 2007). Fourth is administering sedation- it prevents ICP increa ses. A study of 17 patients with severe TBI found ICP was significantly higher and there was a significant decrease in CPP with endotracheal suctioning among patients who were inadequately sedated compared to those patients who were well- sedated with proforol (Gemma et al., 2002) According to the study, a randomized controlled trial of 42 patients with TBI found the use of Proforol (rather than morphine) resulted in significantly lower ICPs by post- injury day 3, with less use of neuromuscular blockers, benzodiazepines, and barbiturates and less CSF drainage was required ( Kelly et al., 1999). Fifth is administration of Mannitol is effective in decreasing ICP. Guidelines for Management of Severe TBI, 3rd Edition states, mannitol is effectice for control of raised ICP at doses of 0.25 gms/kg to 1.0 gm/kg body weight (Brain Trauma Foundation et al., 2007). The diuretic effect of mannitol can cause increase Na+ and serum osmolarity levels, this should be monitored at regular intervals . Mannitol is infused via IV bolus through a filter. Mannitol 20% contains 20g of mannitol in 100cc. 80% of 100g dose appears in the urine within 3 hrs. of infusion. Sixth is to elevate head of bed (HOB) 30 degrees to maintain or decrease ICP- this is thought to promote intracranial venous return and increase CSF drainage from the head, resulting in decreased ICP (Fan, 2004). Four controlled studies with sample sizes ranging from 5- 38 patients with severe TBI found significant decreases in ICP with HOB elevations of 30 degrees (Moraine, Berrà ©, and Mà ©lot, 2000; Ng, Lim, Wong, 2004; Schulz- Subner Thiex, 2006; Winkleman, 2000). Seventh is removing or loosening rigid cervical collars- according to the study, it may decrease ICP. These collars may hold back venous blood flow and cause pain and discomfort, elevating ICP. Eight is administering intensive insulin therapy- it may reduce ICP. Hyperglycemia is common in severe TBI and has a negative effect on outcome. A study was con ducted with a result of lower mean and minimal ICPs to those treated with intensive insulin therapy to maintain glucose levels lower than 110 mg/dl than in subjects treated with insulin only when their glucose levels exceeded 220 mg/dl. The ninth is maintenance of normothermia- it may prevent ICP increases. Hyperthermia is prevalent in the TBI population, as high as 68% within 72 hours of injury (Rumana, Gopinath, Uzura, Valadka, Robertson, 1998). There have been no long- term outcome studies in the effect of normothermia in TBI, but a study found an increase in brain temperature was associated with significant increase in ICP; as fever ebbed, there was significant decrease in ICP. In controversial treatments for refractory intracranial hypertension, first is the inducing of moderate hypothermia- it may decrease ICP in refractory intracranial hypertension. There are multiple human studies that have demonstrated decreased ICP with the induction of moderate hypothermia (33-36 degrees Celsius) in patients with severe TBI (Clifton, Miller et al., 2001; Marion, Obrist, carlier, Penrod, Darby, 1993; Polderman, Tjong Tjin, Peerdeman, Vandertop Girbes 2002; Tokutomi, Miyagi, Morimoto, karukay, Shigemori, 2004; Tokutomi et al., 2003). Second is admistering hypertonic saline. Third is the administration of high- dose barbiturates- are thought to suppress cerebral metabolism, reducing cerebral metabolic demand and cerebral blood volume. In maintaining adequate CPP or increasing CPP, first is maintaining CP b/w 50- 70mmHg- optimized cerebral perfusion (Brain Trauma Foundation et al., 2007). Second is administering norepinephrine, it may maintain adequate CPP or increase CPP. Third is elevating HOB 30 degrees- not only it increases venous drainage from head, it also can decrease perfusion. Fourth is CSF drainage- the decreasing volume of CSF decreases total intracranial volume. In preventing DVT, pharmacologic treatment may be safe for DVT prophylaxis. Agency for healthcare Research and Quality recommends use of prophylaxis to prevent venous thromboembolism for at- risk patients. In adequate nutrition, first initiating nutrition within 72 hours of injury- according to the study, it may improve outcomes. It is recommended that patients be fed so that full caloric requirements are met by post injury day 7 (Brain Trauma Foundation et al., 2007). Second is providing continuous intragastric feeding- it may improve tolerance. According to the study, continuous feeding was better tolerated and achieved 75% of nutritional goals faster than bolus feeding in 152 consecutive patients admitted to neurosurgical intensive care units (20% of whom had sustained severe TBI; Rhoney, Parker, Formean, yap, Coplin, 2002). In preventing seizures, administering antiepileptic drugs decreases incidence of early posttraumatic seizures. Guidelines for the Management of Severe TBI, 3rd Edition recommends the use of anticonvulsants to decrease the incidence of post traumatic seizure within the fisrt 7 days of injury when the brain is particularly vulnerable to secondary injury- involves multiple metabolic mechanisms that result from interruption of blood flow and oxygen to undamaged cells, producing anaerobic metabolism, inadequate synthesis of ATP, or cellular acidosis. Then continuous EEG monitoring has been used to identify a 20% seizure incidence with 50% of patients identified as non-convulsive (Vespa Nuwer, 2000) Reference: Nursing Management of Adults with Severe Traumatic Brain Injury, AANN Clinical Practice Guidelines Series

Dissatisfaction and Mortality Essay -- Literacy Analysis

In Gustave Flaubert’s Madame Bovary and Ivan Turgenev’s Fathers and Sons, the protagonists experience multiple conflicts with society as a whole and with their own place in that society. Emma Bovary and Yevgeny Bazarov, respectively, determine that the solution to their struggles is suicide. By revealing their characters’ reasoning, methods, and legacies, Flaubert and Turgenev seek to expose a fundamental human need for a sense of societal belonging through the resultant act of suicide, should that need go unfulfilled. The sense of despair that is linked to both Emma’s and Bazarov’s suicides originates from their stark incompatibility with the societies into which they were born. Each protagonist goes through a life long struggle to reshape his or her own niche in the community, in a manner reminiscent of attempting to force a key into a lock that it does not fit. Emma, who was brought up in a rural peasant family, had aspirations for a different place in life beginning as a young girl in a convent school. She kept a collection of â€Å"portraits of unidentified aristocratic English beauties† (Flaubert 872). By marrying Charles Bovary (a doctor), Emma raises herself up to the comfortable level of middle class; however, she clearly remains unsatisfied, as she obsesses over magazines from Paris, fills her house with luxury items, and pines for any contact with the upper class. Bazarov also has a more desirable relationship with society in mind. However, unlike Emma, he does not crave for changes in his own lifestyle, but instead he wishes for the majority of society to conform to his ideals. Upon meeting Arkady’s aristocratic father and uncle, Bazarov attempts to persuade them into agreeing with his progressive nihilistic views. He la... ...rimarily in the parallel legacies left behind by Emma and Bazarov. By focusing on their respective protagonists’ reasons and means for committing suicide, as well as their lasting impacts, nineteenth-century novelists Flaubert and Turgenev reveal the importance of possessing a sense of belonging in one’s society. These authors employ Emma’s and Bazarov’s preoccupations with advancing themselves in the eyes of society in order to convey the theme that putting forth such efforts is generally unnecessary (or even counterproductive) to lead a fulfilling life. Works Cited Flaubert, Gustave. Madame Bovary. 1856. Trans. Francis Steegmuller. The Norton Anthology of World Masterpieces. Ed. Sarah Lawall. 7th ed. Vol. 2. New York: Norton & Company, 1999. 850-1063. Print. Turgenev, Ivan. Fathers and Sons. Trans. Peter Carson. London: Penguin Classics, 2009. Print.

Learning Experience Essay

For the past years in college, I have faced situations that needed intelligent decisions. Though many times I have considered the possible consequences, nothing could prepare me when I faced them. In the end I always realize that I have made the wrong decisions, and I could not turn back time to change them. However, these experiences taught me lots of things that helped me to become a better decision maker. I admit that there is a part of me that always tries to avoid making the boldest decisions, despite the fact that they are the safest (Arsham, 1994), as it appears risky to me. Moreover, there were times when these decisions are nerve-racking and difficult and I was often left scared to deal with the outcome. At one point in my life, I experienced losing friends who have been with me for years. I did not notice that slowly they were pushing me down despite our friendship. And even if this one person who I just met for a few months warned me about how my ‘friends’ back-stabbed me, I did not believe her because I knew my friends better, or so I thought. It was hard for me to accept that they, out of envy, would tell bad things about me. I have confided in them, my life was an open book to them, and I trusted them with my whole life. Then one day, all of their hate words reached me. I was in shock, because my friends treated me well whenever I am around. I was in a state of denial for a few weeks. During those weeks, I was like another person. I was apathetic and unemotional (Messina, J, and C. Messina, 2007). It was like those years of friendship that we have built for almost three years were broken in just a few days. Later on I was angry at them. And then I realized that my anger was a reaction for being hurt and insulted (Richmond, 2008). The hardest part was turning my back on them because I knew I do not deserve to be friends with persons who would deliberately say bad things about me. It was really a difficult decision, because somehow I have treasured those moments when we were genuinely happy with each other’s company. What made it more difficult was seeing them in places where we have hang out before. Seeing them always reminded me how I was not careful in choosing people who would be a part of me and my life. Up to this day I am still hurt when I think about them. But the good thing is that I became better at choosing friends. I do not judge somebody easily, but since then I have found friends who are better than best. And that is enough for me. References Arsham, H. (1994). Leadership decision making. Retrieved December 15, 2008, from http://home. ubalt. edu/ntsbarsh/opre640/partXIII. htm Messina, J. J. , and C. Messina. (2007). Tools for handling loss. Coping. org. Retrieved December 15, 2008, from http://www. coping. org/grief/denial. htm

Free Goodfellas Informative Essay

Free Goodfellas Informative Essay Goodfellas Introduction Crime and American gangster films focus more on the sinister motives of gangsters, especially the criminal figures who operate outside the limits of the law. The crime stories depicted in gangster films usually draw attention to the gangster lifestyle in the sense that they glamorize the rise and fall of a gangster. Most of the gangster movies produced before the 1960s associated gangsters with immorality and unlikable by the larger society, who in most cases ended up being killed or caught by law enforcement. The fundamental moral lesson that are derived from the gangster movies produced before 1960s is that gangsters were villains who caused chaos and evil in the society that was morally upstanding; as a result, the gangsters deserved unhappy endings that they usually received. The Goodfellas is a perfect idolization of the rise and fall of a gangster, which serves to indicate some level of consistency with the moral lessons depicted in most gangster movies. The moral lesson in Goodfellas is consistent with the view that gangsters are villains and bring about chaos; therefore, they usually deserve unhappy endings. The outcome of the end of a gangster lifestyle is notable by the end of the glamour and the beginning of contact with the criminal justice system. In most cases, gangsters are not successful in their endeavors; they turn out to be the losers. However, Henry Hill, who is the main protagonist in the film, is a sympathetic hero that the audience would want to succeed. Despite his initial entry into gangster life by adhering to the codes of conduct, Henry Hill defies these rules, mentions the names of his fellow gangsters including Jimmy and Pauly. In addition, he was a principal witness against them so that he could receive an enrollment at the federal witness protection program. Henry Hill is sympathetic hero because never killed anybody and he is against the brutality and violence of Tommy when undertaking their gangster activities. Despite the fact that he helps Tommy in covering up evidence, he is remorseful regarding the kind of life that he is living. Among all the characters in the movie, Henry Hill is the closest thing to a hero in the movie. The motivation of Henry Hill in criminality is mainly due to his notion of good life. Henry has always wished to be a gangster and considers it as being the best thing when compared to being the president of the United States. This indicates that Henry Hill is not a hero under ordinary circumstances, but turns out to be the closest character that is suitable for the title of a hero. Henrys motivation into criminality is mainly due to his view of a good and successful life Henry always wished to be a part of something that is significant, which resulted to the quitting of schools and becoming involved with gangster activities. His motivation for the gangster life is due to the idolization of the Lucchese crime family gangsters and admits that he has always wanted to be a gangster. Given his viewpoint of success and good life, this movement seems justified since the gangster lifestyle did not get him by chance; rather, it was his dream. There are redeeming qualities that Henry posses. For instance, in the course of his gangster life, he did not kill anybody and that he revealed the names of his fellow villains. However, these qualities are not adequate to keep him from being a villain, owing to the fact that circumstances forced him to do act so. In conclusion, the moral theme in Goodfellas is consistent with the depictions of gangster movies before the 1960s that portrayed gangsters as villains and immoral, who brought about chaos and evil in a society that was morally upstanding.

A Facebook Ads Strategy That Will Skyrocket Conversions With Amanda Bond

A Facebook Ads Strategy That Will Skyrocket Conversions With Amanda Bond As marketers, you’ve probably been told that you have to pay to play. But how do you make the most out of what you put in? People buy from people who they know, like, and trust. Today, we’re talking to Amanda Bond, owner of Ad Strategist. She tells us how to get more results from our Facebook ads, how much to spend on ads, and how to scale the use of ads. She shares her â€Å"secret sauce† comprised of a 3-step formula that goes from engagement to purchases. Some of the highlights of the show include: Stop guessing, get results with Facebook ads; manage ads to get a better ROI As Facebook ads gain popularity and attract more advertisers, cost for them will only continue to rise; stay ahead of growth curve and remain competitive The Strategy System: Put people through a customer journey Connect, Commit, and Close Connect: Amplify content, put the brand out there, and engage your audience; review Facebook Page Insights to identify how your organic content performs Commit: For lead generation, Ad Strategist only targets warm custom audiences; a custom audience is one that has previously interacted with your brands Close: When you set up your Facebook ad, it is the first thing you do; patch up holes of close/sales retargeting ads for them to convert to purchase decisions Take 3 main objections submitted to customer service and turn them into Facebooks ads to overcome those objections and increase sales conversion rate Make sure you can sell an offer before spending lots of money on Facebook ads Continue to fill pipeline with new members and scale sustainably by figuring out what information an audience needs to know to make a future purchase decision Targeting broad audiences can be just as cost-effective; power of Facebook ad tools and optimization If brand new to Facebook ads, don’t start Facebook advertising before you understand your earnings per lead Links: Ad Strategist Facebook Page Insights Write and send a review to receive a care package If you liked today’s show, please subscribe on iTunes to The Actionable Content Marketing Podcast! The podcast is also available on SoundCloud, Stitcher, and Google Play. Quotes by Amanda Bond: I really encourage people who want to jump in or want to get better results, to really understand what’s going on with Facebook ads in general so they can stay ahead of that growth curve. The thing that we do differently when it comes to that lead generation is, we’re only targeting our warm custom audiences. Really, when it comes to scaling, first you need to make sure you understand the customer journey that you’re trying to get people to go through, then start with lookalike audiences.

MID TERM Essay Example | Topics and Well Written Essays - 500 words

MID TERM - Essay Example On politics as the conduct of governing, Section 17 of the Tao Te Ching provides a pointed observation: "When the Master governs, the people are hardly aware that he exists." This can be interpreted to mean that in a state of benevolent governance, well being of the people, even prosperity, is assumed as natural occurrence that people become less conscious of the governing authority. Then he proceeds, "Next best is a leader who is loved. Next, one who is feared. The worst is one who is despised." And we can not argue with that. Section 57 also provides wisdom that people who govern can reflect upon: "The more prohibitions you have, the less virtuous people will be. The more weapons you have, the less secure people will be. The more subsidies you have, The concept of war as armed conflict, however, does not appear to conform with the principles Lao Tzu espoused. Section 31 begins, "Whoever relies on the Tao in governing men doesn't try to force issues or defeat enemies by force of arms. For every force there is a counterforce.

Police ethics Essay Example | Topics and Well Written Essays - 500 words

Police ethics - Essay Example The enormous powers enjoyed by these detectives must be tamed through some strict checks on their ethical conduct in exercising these powers at right spot and the correct manner. While having such powers in most cases is a legal necessity but justified and dignified application of these powers is often an ethical issue. In United States there are several documents at national level like Declaration of Independence, the U.S. Constitution, its Bill of Rights and the Federalist Papers which are meant to enforce these ethical guidelines. However there is a lack of education and implementation in this connection. The tools and trick that are used in an investigation also provides a ground for ethical arguments and concerns. For example the use of sex and friendship in undercover investigations are very common tools for the police detectives but their ethical issues are lease bothered at higher level in the department. However, police ethical misconduct in using these undercover investigat ion tools is highly probable.