Case summary and examination of Obstetrics Posting

Case summary and examination of Obstetrics Posting Madam NTR is a 34 years old Malay lady with gravida 4 and parity 3, currently at 37 weeks of gestations. She was admitted on 21st Nov 2010 at gestational age of 30 weeks and 1 day, due to referral from Health Clinic Sendayan in view of placenta previa based on ultrasound findings during a routine antenatal visit. Her estimated date of delivery was on 20th Jan 2011. She was asymptomatic with no complaints of per vaginal bleeding, contraction pain, leaking liquor or show. Fetal movements were felt and were not reduced. She has no history of placenta previa in her previous pregnancies. The first day of her last normal menstrual period was on 15th Apr 2010. This was an unexpected pregnancy but both her and her husband wanted it. She suspected she was pregnant when she missed her menses for 4 weeks. She confirmed her pregnancy after urine pregnancy test done in a private clinic yielded positive result. Booking was done in Maternal and Child Health Clinic Gadong at 16 weeks of gestation a nd the dating scan at 16 weeks revealed parameters corresponding to date. However, placenta was noted to be low lying during that scan. Throughout her routine antenatal visits, she was normotensive, not anaemic and did not have diabetes mellitus. HIV and VDRL test were negative. Her blood group type is O Rh DÂ  positive. This is her fourth pregnancy. Her third pregnancy was in the year of 2007. She delivered a full term baby boy with birth weight of 2.6 kg via caesarean delivery due to breech presentation in Hospital Tuanku Jaafar Seremban. She delivered her first two children who are both males in the year of 2004 and 2005 via spontaneous vaginal delivery, with birth weight of 4.26kg and 2.6kg respectively. There was no history of shoulder dystocia. All her children were born alive and well. Antenatal, natal and postnatal for all previous pregnancies were uneventful. She attained menarche at the age of 12. It is regular at 28 to 30 days cycle with duration of 5 to 7 days. There wa s neither dysmenorrhea nor menorrhagia. She practised coitus interuptus as contraceptive measure. She never had any PAP smear done previously. Past surgical, medical and drug history were unremarkable. Family history was unremarkable. She and her husband are married for 7 years. They are staying together with their three children in Gadong Jaya Village. She is a housewife. She neither smokes nor drinks alcohol. On the other hand, her husband works as a construction worker. He is a smoker but not alcoholic. Family income is approximately RM2000 per month which is barely adequate for their living. Physical examination: Madam NTR was alert, conscious and communicative. She was not in pain or respiratory distress. Her height and weight are 165cm and 76kg respectively. Her blood pressure was 110/80 mmHg; pulse rate was 86 beats per minute of regular rhythm and strong volume; temperature was 37Â ° C; respiratory rate was 19 breaths per minute. All vital signs were within normal range. Up on general examination, there was no conjunctival pallor, sclera jaundice, palmar erythema or peripheral cyanosis. Thyroid glands were not palpable and breast examination was unremarkable. There was bilateral pedal edema up to mid-shin. Cardiopulmonary examination was unremarkable.

History- World War I Essay Example | Topics and Well Written Essays - 500 words - 2

History- World War I - Essay Example From the many quantifiable losses of WWI we consider further some of the major impacts of the war as far as the civilian populace is concerned. First, the war created a major social and moral blow upon the society resulting to social disorders (Bourne, â€Å"Total War,† par. 62). Most of the European states involved in the war like Russia, Germany, and Italy experience social chaos. Political leaders are finding reasons for their failures and created oppositions from various sectors. The weak governments that were created after the war invited new ideologies to come out. The leaders and the populace are looking for identity which leads to the rise of ideologists that created totalitarian regimes in their desperate moves to control society and return the country to order. The rise of Mussolini, Hitler, and Stalin are proof to this argument. The effects could have lasted if not for the eruption of another war as the consequence and the end to major autocratic regimes. The wars t hat erupted changed the perspective of the people against the use of power to resolve conflict and this effect lasted until now where the general public favors diplomatic resolutions against violence. These facilitated the birth of International Peace Organizations like the League of Nations, predecessor of the United Nations in the worlds attempt to control global order (Townshend, â€Å"The League of Nations.† Par. 1) The emotional trauma was equally important aftermath of WWI. This trauma is brought by deaths of fathers, mothers, sons, daughters, relatives and friends. However, the effects vanished or reduced in intensity as years passed as new generations replaced those who were directly involved in the war. But war memorials, which still stand until this time, served as reminders to mankind of the consequence of his actions. In the economic side, some countries gained while others losses. Much of Europe became economically burdened due to the cost of war including

Knowledge is generated through the interaction of critical and Essay

Knowledge is generated through the interaction of critical and creative thinking. Evaluate this statement in two areas of knowle - Essay Example People need to only reflect on how whoever writes history develops greater power and it becomes too painfully real how knowledge enhances different forms of power, including political and economic power. How people acquire knowledge and define it, however, is highly debated. The rise of emotional intelligence, for instance, questioned knowledge as pure logic. Feminists aim to call emotions and perceptions as equally valuable sources and components of knowledge. Some also argue of the unification of creative and critical thinking, because they are related and more effective in generating knowledge together (Mayfield 4; Paul and Elder 118). This paper evaluates this belief using the areas of knowledge of ethics and sciences. Knowledge is generated through the interaction of critical and creative thinking. Ethics refer to the people’s guiding principles of what is right or wrong (Means 52). Ethics uses both critical and creative thinking skills. This paper first defines and diffe rentiates critical thinking and creative thinking. In the traditional TOK Diagram, see figure 1 below, the ways of knowing are through emotions, reason, sense perception, and language. Creative and critical thinking are both ways of knowing, but they are closely interrelated (Paul and Elder 118). Critical thinking analyzes and evaluates a particular material, while creative thinking concerns inventing something new (Mayfield 4). Creativity, however, has a â€Å"critical component,† and not just portraying â€Å"imagination† or â€Å"inventiveness† (Paul and Elder 118). In business, for instance, creativity is valuable if it leads to innovation of products, services, processes, and systems. Creativity must also have a critical output too. In connection to the TOK diagram, critical thinking primarily involves reason and language, or the right side of â€Å"knowing† in the TOK diagram. Creative thinking uses emotion and sense perception, or the left side of â€Å"knowing.† Reason and language are often used by sciences, but ethics employ emotion and sense perception too. But clearly, the diagram is a circle. It shows the unity of all forms of knowing for all areas of knowledge. Ethics uses reason and language too. It must be reasonable to be embraced by people, and it must also use persuasive language to convince people of its effectiveness in differentiating right from wrong. Knowers should be able to use all four ways of knowing to arrive at a balanced and ethical decision or option (Paul and Elder 118). Figure 1: Traditional TOK Diagram Ethics cannot be arrived at by using only emotion and sense perception; it also needs the guidance of reason and language. An example is the ethics developed by Immanuel Kant. Kant argues that people should be responsible for their moral actions and they have a duty to act morally (Bartlett 224). This is based on both the emotions of doing what is right and the reason for choosing right over w rong. Emotions are important to ethics, because some people need to feel that they are doing the right thing. For instance, merely following instructions from a superior can seem right, but it can also feel wrong. This can be related to employees of Enron, who followed their corrupt executive managers, because they also wanted to be rich and improve the stock price of Enron. It seems right to be doing this for the company, but it feels wrong, because they are duping their shareholders, as well as their diverse stakeholders. Perceptions are further

Management Accounting for Business Decisions Essay

Management Accounting for Business Decisions - Essay Example In the case of CoolSchool and Scrubs, differences in operations present the greatest challenges to the whole merger. The new company resulting from the merger will have new dynamics and set of accounting challenges which must be addressed in order to ensure success (Bierman 2010). CoolSchool supplies school uniforms at the beginning of the school year and the number of uniforms is based on the previous year’s enrollment. It is important to note that despite the merger, there will still be an important need to ensure that uniforms are supplied to the schools every year and on time. In addition, it is difficult for schools to provide the exact number of uniforms they shall need. In this respect, it becomes necessary for the company to continue its present production method which uses estimates from the previous year. However, this can be further improved to enhance accuracy. Since CoolSchool has supplied uniforms to schools for a number of years, it has records on the supply for every year. By using the record, the new merged company can extrapolate and estimate the enrolment rate in the coming year. Production of uniforms will then be based on the extrapolated figure which will be fairly accurate than using the enrolment for the previous years (Brush 20 08). Regarding hospital uniforms, the new company will easily predict the number based on the staff numbers previously used by Scrubs. Considering the accurate production in this regard, it is important that the new company produces a large amount of uniforms for 8 months. Producing large numbers of uniforms on a single occasion helps the company to enjoy the economies of scale associated with large scale production. In addition, hospitals will always require new uniforms and the company should not therefore worry about any excess inventory (Gleich 2010). Producing a large amount of hospital uniforms at one time will help the company in creating

History of Communication Essay Example | Topics and Well Written Essays - 1250 words

History of Communication - Essay Example Following the emergence of the recent technological innovations such as the cochlear implants, issues of community, language, unification and identity keep on becoming rampant. (Deaf Culture: Introduction) Following various efforts, the ultimate achievement was witnessed with the establishment of the Columbia Institute for the Deaf at Washington, DC in 1864. The later portion of the 19th century saw the growth of the oral theories of deaf education. Even though a lot of these theories persist, they have in common a stress on the value of acquiring oral skills, i.e. reading and speech in the educational training of the deaf children. It is very important to note that a major supporter of technique of oral methods was Alexander Graham Bell whose mother and wife had problems in hearing. The first important oral school in the U.S., Clarke School for the Deaf in Northampton, Massachusetts was opened in 1867. This variation in philosophy between the supporters of conventional sign language and those who are in favor of oral language formed a vital division across the second half of the 19th century as well as the 20th century. The differences were sometimes strong, resulting in intense divi sions within the deaf education community. (History of Deaf Education in America) The capability to educate in oral skills depends largely on the extent of hearing loss, the age in which the student lost his/her hearing ability particularly if it was prior to or following acquisition of the sign language and other factors as well. Thus there is broad array of achievement and failure dependent, which is not on intelligence, rather on these factors. During the history of development, oral skills are not generally very helpful for communication among deaf persons, and the application of the oral techniques really prevents the deaf from careers as teachers. The American School for Deaf at this time, tried out students in oral classes initially, and in case they did not get results, placed them in manual classes as an alternative, under a philosophy known as the Combined System. A lot of other schools meant for the deaf accepted the oral method to a greater degree. The 20th century witnessing a scenario wherein the oral method was losing its popularity to the sign met hod which was gaining increased acceptance. (History of Deaf Education in America) The difference between spoken language and sign language, while crucial for researchers, is a sweeping statement for most real-life situations. It is exceptional that deaf children are subjected to spoken language or sign language, even if this is the purpose of their parents or teachers. As per data relating to the year 1999, roughly 55% of deaf children in America are officially enrolled in programs which state suing of sign language solely just more than 5% or signed and spoken language in combination just more than 49%. (Albertini; Lang; Marschark 89) One more aspect observed in the Ralph Fasold authored publication entitled "The Sociolinguistics of Society" gives an account of the essence of sociolinguistics that is dependent on two facts regarding language. First of all, that language changes which is to state that speakers have more than a single means to speak roughly the same thing. The second aspect is that language serves a widely inclusive objective just as important one of

Enhancing the Patient Experience Essay Example | Topics and Well Written Essays - 2250 words

Enhancing the Patient Experience - Essay Example Specifically, the patient journey and challenges incorporated the actual healthcare experiences with the textbook knowledge. The experience adds a new aspect to nursing care learning. The new knowledge delves into the importance of â€Å"person-centred care† (http:learn2.open.ac.uk 2012). Further, the journey experiences convince the nurse that learning includes gathering inputs from the healthcare environment (http:learn2.open.ac.uk 2012). The inputs include the patients’ inputs. The healthcare environment indicates that the patients have different culture-based inputs. The nurse compares the patients’ inputs with current medical databases. Tiago (2011, p. 268) reiterated â€Å"With the synergies and differences between the different theories and models that analyze and predict the acceptance of technology, its explanation identifies the advantages and disadvantages associated with them as well as a clear identification of variables that interpret end-user moti vation to accept IT/† Tiago (2011, p. 268) that a research of 43 Portugal medical doctors used the Electronic Medical Database system for their diagnosis and prescription activities. The doctors have different specializations. Consequently, the doctors tailor their database on their medical expertise. For example, the oncology expert keeps a cancer-related database Furthermore, the experience lessons persuade the nurse to search for references that will ensure positive outcomes from the patient-centred healthcare approach (http:learn2.open.ac.uk 2008). Positive output includes client’s receiving significant psychological benefits. Ella Stiles (2011, p. 35) theorised â€Å"To achieve best outcomes, patients must have a good understanding of the condition and should adopt a vigilant self-care approach. However, this may be difficult for patients with low health literacy because they may struggle with obtaining, understanding and applying health information.† The nu rses must encourage the patients to do their share in the healing process. The nurses cannot fully implement the healing process without the patients’ voluntary implementation of the medical doctor’s prescriptions. For example, the nurses should persuade the hypertensive patients to avoid fatty foods because fatty foods trigger the hypertension attacks. In addition, the positive outputs of the patient journey learning experiences include the nurses’ gaining psychological advantages from the patient-centred hospital experiences. Arturo (Bustamante, 2011, p 1921) states â€Å"physicians with 50 percent or more Latino patients were more likely than the reference group to report inadequate time with patients, patients' inability to pay, the lack of qualified specialists in their areas, not getting timely reports from other physicians, difficulties communicating with patients, and patient noncompliance with treatment.† ‘ The quote clearly shows that the language barrier reduces the implementation of a favorable communication between the Spanish-speaking Latinos and the English-speaking healthcare professionals. The research indicated that medical professionals serving more than 50 percent Latino patients’ medical needs had lesser confidence in their ability to communicate with the Latino patients, reducing the required healthcare quality service. Further, the patient journey experiences enrich the nurses’ knowledge that the healthcare practitioners, especially the nurses, must

Work-Life Balance Essay Example | Topics and Well Written Essays - 1500 words - 1

Work-Life Balance - Essay Example Work-Life Balance As one of the CEOs has noted, people working for him need to have phones even in the bathrooms. Traditionally, business ethics is focused on the morality of action. Therefore, overwork and work-related stress caused by the lack of opportunity to spend enough time with family is the ethical problem which needs to be addressed. Mary in the mother of two small children and is the manager of the large department of the growing company. One day she faces the following situation: her children are sick, but she has to give the major presentation to 200 people who have traveled hundreds of miles to hear it. What should be done? The one may answer that Mary should rather take care of the children. While, most of the people would agree that the job will suffer if Marry blows this off. For most working men and women this situation is the reality, even in those companies which pay enough benefits for maternity leave and have other policies of flexible employment. Over the last 20 years, the hours people spend at workplace has raised steadily. According to the statistics, more than 40 percent of American employees feel that their workload in excessive. Moreover, the average working week (40 hours) does not provide sufficient income for the families. Another factor why people overwork is downsizing and the fear to lose the job. Downsizing has created the surplus in workload as well as increased insecurity – employees feel they need to do extra job or they will lose their place in the company. Such situations are morally questionable about the ethical right of employers asking the employees to do the extra job. Despite of the causes or motivators why people spend more and more time at work, finding the work-life balance has become the major ethical dilemma not only for working mothers, but also for the working husbands and fathers. Changes and Dilemma Resolution The ethical dilemma of work-life balance has been addressed by many organizations. In particular, the federal government of United States has introduced the flexible working hours and child care in 1996 (Deckman 1996). In 1996, the number of working mothers increased and organizations were forced to find the new ways to provide them with the opportunity to balance work and non-work priorities. The following changes were introduced into employment practices: flexible work schedules, on-site child care, flexible leave policies and other benefits. These were the first significant initiatives aimed at enabling employees to meet their family responsibilities. The special attention should be devoted to the flexible work schedules which were supposed to relief working parents from work-life balance ethical strain. First, the flextime means the system of work scheduling when the working day is split into two time periods: core time and flexible time. Employees are obligated to be at work during the core time and are accountable for the total number of hours scheduled to work (Deckman 1996). Unfortunately, there are very few studies available concerning the flexible scheduling benefits and even less studies addressing the impact of flextime on employee's family life. Employers might think that flextime is the solution for all employees in helping to balance work and life; nevertheless, the research indicates that there is only insignificant difference between the stress of parents who do and do not use the flexible work