Recent orders
To maintain patients independence by preventing injury and removing hazards from home environment.
Patient Name: Mr Sylvester
Nursing Issue: Risk of injury due to falls, related to decrease visual acuity and physical environmental hazards.
Goal/s: To maintain patients independence by preventing injury and removing hazards from home environment.
Interventions Rationales
Review and discuss findings from home hazard assessment with Mr Sylvester and daughter, Mrs Martin (Crisp & Taylor, 2009).
Assess Mr Sylvester’s level of mobility and balance using the ‘Timed Up and Go Test’ and the ‘Sit-to-Stand Test’ (Australian Commission on Safety and Quality in Health Care, 2009).
Determine whether Mr Sylvester is taking any medication that may increase risk of falling, if confirmed schedule appointment with doctor to explore alternatives (Farley, McLafferty & Hendry, 2011).
Install handrails on front and back steps, indoor stairway, hallway and bathroom (around shower, bath and toilet). (Zona, 2007).
Mark the edges of outdoor steps with white paint (Australian Commission on Safety and Quality in Health Care, 2009).
Install non-slip rubber mats and shower chair in bathroom (Expositor, 2008).
Install 75-watt, non-glare light bulbs throughout house, and night-lights with motion sensors in bedroom, bathroom and hall (Crisp & Taylor, 2009).
Discuss with patient relocating current bedroom to the infrequently used lounge room downstairs, and remove loose carpet and clutter (boxes and chairs). (Gates, Fisher, Cooke, Carter & Lamb, 2007).
Refer patient to an optometrist/ ophthalmologist to determine whether reduced visual acuity may be improved (Crisp & Taylor, 2009).
Ensure that Mr Sylvester wears supportive, well-fitted, flat shoes with good traction (The Prince George Free Press, 2008).
Ensure that there are no loose pavers in backyard, or protruding roots from trees near walking path or clothesline (Department of Health and Aging, 2006).
Refer to physiotherapist to discuss various exercise options that will improve strength and balance, and to assess the need for any walking devices (Australian Commission on Safety and Quality in Health Care, 2009). It is important for Mr Sylvester and family members to be aware of the risks associated with the current living environment, and changes that need to be made to ensure safety. Educating patients about the risks associated with falls improves confidence and reduces fear of falling. Encouraging Mrs Martin to be involved wherever possible, and communicate with her father will provide support, and the opportunity for Mr Sylvester to express emotions, needs and fears (Holland, Jenkins, Solomon & Whittam, 2008).
Recommended by the American and British geriatrics societies for elderly persons who have experienced a fall. The Timed Up and Go test involves rising from a chair, walking 3 metres, then returning to sit in the chair. The time taken to complete test indicates the level of steadiness. The Sit-to-Stand Test indicates level of lower limb strength, coordination and speed. This is measured by the time taken to rise 5 times from a chair without the use of arms. Such tests will help to identify factors contributing to Mr Sylvester’s falls (Australian Commission on Safety and Quality in Health Care, 2009).
Various medications may increase the risk of falls by increasing drowsiness and confusion, for example those containing sedatives and diuretics (Farley, McLafferty & Hendry, 2011).
Handrails will improve steadiness in areas of the home where falls commonly caused, in particular moving up and down stairs, and around bathroom (Zona, 2007).
Highlights each step making it easier to see and reducing the risk of falling (Australian Commission on Safety and Quality in Health Care, 2009).
Non-slip rubber mats provide traction on slippery tiles and wet surfaces (Expositor, 2008).
Adequate illumination will improve patient’s perception of surroundings, making it safer to move around the home. Night-lights will help orient Mr Sylvester when he needs to get out of bed during the night. Motion sensors will also reduce the risk of falling associated with searching for a switch in the dark. (Crisp & Taylor, 2009).
Relocating bedroom to downstairs will save Mr Sylvester the need to negotiate up and down the stairs. The removal of boxes and chairs from patient’s bedroom will reduce obstacles which pose trip hazards. Removing loose carpet on polished floorboards will also reduce the risk of slipping (Gates, Fisher, Cooke, Carter & Lamb, 2007).
Vision deteriorates with age. Mr Sylvester has expressed that he “can’t see well enough” to read anymore. Vision impairment negatively affects many aspects of life, increasing the risk of falls, reducing ones ability to perform daily activities, and has been proven to increase rates of depression and suicide. An eye care practitioner may be able to prescribe appropriate visual aids and/or treatment to improve Mr Sylvester’s vision (Crisp & Taylor, 2009). The ANMC (2006) states that nurses must initiate “necessary contacts and referrals…”.
Loose footwear, for example slippers, increases the risk of falling. Wearing footwear with good traction increases friction and reduces risk of slipping (The Prince George Free Press, 2008).
Raised objects and uneven surfaces pose tripping hazard (Department of Health and aging, 2006).
2 hours of exercise per week has been proven to reduce both the rate and risk of falls in aged people. A trained physiotherapist will individually assess the patient and prescribe an exercise programme that is challenging and safe. For example, Tai Chi has reduced falls in the elderly population, and is a group-based activity, which may improve Mr Sylvester’s social wellbeing by interacting with the community. The Otago Exercise Programme provides the option for Mr Sylvester to exercise from home, and is individually tailored to improve walking, limb strengthening and balance (Australian Commission on Safety and Quality in Health Care, 2009). Through prevention of falls, exercise may improve patient’s confidence and reduce anxiety related to fear of falling (Clemson & Swann, 2008). Proper training in the use of walking devices can improve mobility and confidence, and maintain independence (Farley, McLafferty & Hendry, 2011). Maintaining independence and mobility will reduce the risk of depression related to isolation from social interaction, thus benefiting patient’s psychological wellbeing (Brownie, 2006).
TO KILL A MOCKINGBIRD
TO KILL A MOCKINGBIRD
Name
Date
To Kill a Mockingbird
To Kill a Mockingbird is an autobiographical novel which was written by Mary McNough. It gives an inspiring story about an enduring Atticus who used his extraordinary courage to do what ordinary men can not do. This paper compares two different characters who demonstrated bold and cowardice traits according to Atticus’s point of view.
To begin with, Scout is portrayed as a very courageous character. Although she is just a six-year-old girl, she managed to use her braveness to surprise many leaders. First, she confidently fights her fellow students who wanted to spoil her father’s name. She goes ahead to boldly defy her father’s directives not to attack them. Instead, she decides to tell them that her father should not be condemned for defending Tom Robinson who had been innocently accused of raping Mayella. Besides, together with Jem and Dill, Scout shows her boldness by openly rebuking the mob who wanted to lynch her father. Their violent pressure does not only compel the mob to leave her father alone, but to flee.
On the other hand, Simon Finch comes out as a coward character. Unlike Scout, he acts contrarily. His decision to flee from England to America was an act of cowardice. If he were bold, he would have persevered to continue living there even if there was religious intolerance. It means that he feared war to the extent that he could not confront the same challenge. Instead of escaping to a safer place, he would have joined others in the liberation struggles for his community. Because of his cowardice, he opted to relocate to Alabama, where he accumulated a lot of wealth and had a very comfortable life.
Conclusively, the conducts of the two characters portray them as totally distinct persons. They confirm Atticus’s definition of courage when he asserted, ‘Courage is when you are liked before you begin, but you begin anyway and you see it through no matter what!’
to inform the audience on the effects of smokeless tobacco on the well-being of an individual
Education: Comm 200 Speech # 4 Outline
Name of student
Name of institution
Purpose statement
The purpose is to inform the audience on the effects of smokeless tobacco on the well-being of an individual. Central idea: the effects of smokeless tobacco to an individual are many and have far-reaching consequences and most people tend to overlook them when they hear about them.
Thesis statement
In order to understand the seriousness of smokeless, one has to consider the problems the individual using it, has to deal with just in the disguise of enjoying a goodness that comes with using it. The problems encountered by people using smokeless tobacco are many cover the whole scope of an individual from health to the economic side. The effects of this habit are many especially in the modern life.
Introduction
The harm of smokeless tobacco is so severe that it harms almost every part of the body. In particular, the habit causes many diseases and impairs the health of many users. Of the approximately 4000 chemical in cigarette, hundreds of these are toxic. These chemicals that are available in both smokeless and smoked tobacco affect the entire being of an individual from organ functions to the decline in immunity. These effects are widespread and destructive ((USDHHS, 2004).
Transition: Let us begin with the chemicals found in smokeless tobacco
Body
The chemicals in smokeless tobacco
According to the US Department of Health and Human Services, USDHHS (2004), cigarettes contain many chemicals. These chemicals include; nicotine, and carcinogens (WHO (2008).
Nicotine travels very fast in the body. It is believed to penetrate and find it way in breast milk (USDHHS, 2004).
The carcinogens damage the genes that are necessary for the normal production of cells in the body leading to abnormal and rapid growth of cells in the body (U.S. Department of Health and Human Services, 2004).
(Visual aid- I will use the picture of smokeless tobacco to explain these points).
Transition: Now that we know the chemical found in smokeless tobacco, let us look at the effects brought about by smoking.
Smokeless tobacco causes cancer
It is believed that smokeless tobacco has carcinogens that can cause cancer to the individual using the product. It is estimated to cause cancer to the users especially in the parts where tobacco is held for a long time (USDHHS, 2004).
Surprisingly the carcinogenic effects of the smokeless tobacco can also spread to the other parts that are adjacent to the mouth. It thus causes the common cancers around this area that include, throat, lips, tongue and cheek cancers (USDHHS, 2004).
(Visual aid- I will use the statistics from the Centre for Disease Control to explain this).
Transition: Having looked at cancer as the leading consequence of smokeless tobacco; let us look at effects of smokeless tobacco on the heart.
Effects of smokeless tobacco on the heart
By virtue of the substance contained in smokeless tobacco, nicotine, the effect of the smokeless tobacco on the heart is immense. The use of this tobacco is believed to cause an increase in the heart rate of the user (WHO (2008).
Additionally, regular use of this product is also believed to cause high blood pressure that is also accompanied by irregular heartbeats in the user (WHO (2008).
Apart from having a potential to cause heart diseases in the user, smokeless tobacco is also believed to be so disastrous to people who already have heart problems. For instance, the adrenaline available in smokeless tobacco leads to clotting of blood. If the hormone is in high amounts in blood it may trigger incidences of heart attack in the users (WHO (2008).
(Visual aid – I will the picture of the cardiovascular system to illustrate this).
Transition: Having looked at the cancerous effects of smokeless tobacco on the cardiovascular system; let us now look at the effect of smoking on the reproductive health of an individual.
Cigarette smoking and reproductive health and the unborn child
The effects of smokeless tobacco on the male body are immense as regards reproduction. It lowers the sperm count and leads to higher incidences of deformed sperms. It also damages the sperm genetically and may lead to impotence due to the damage of the blood vessels supplying blood to the genital area (Peate, 2005).
In women, it leads to declined fertility, changes in the patens of the menstrual cycle and increases the risk of developing cervical cancer (U.S. Department of Health and Human Services, 2001).
In the unborn child, the risks are even higher. There may be miscarriage or still birth. Additionally, the child will have low birth weight that will have a greater bearing on the future development of the child. The child also has high chances of developing cleft lip and palate (Peate, 2005).
(Visual aid- I will use the diagram of an unborn child in the womb to discuss the reproductive effects of smokeless tobacco).
Transition: Having looked at the effects of smokeless tobacco on reproduction; let us now look at its effects on other parts of the body.
SCENIHR (6 February 2008) is additionally of the opinion that this products also have an addicting potential to the users. It is believed that these products are so addictive that withdrawal is similar that those experienced by smokers (SCENIHR, 6 February 2008).
Other effects of smokeless tobacco include; abrasion of the teeth by the constant chewing, the receding of gums leaving the teeth exposed, and increases of the chances of tooth decay and discoloration (SCENIHR, 6 February 2008)
Additionally, use of smokeless tobacco causes Leukoplakia. This is a condition where spots form on the gums and side the cheeks. Occasionally these spots can be seen on the tongue. This is believed to be caused by the irritation of the juice that is secreted when the tobacco is being chewed. This condition, if not managed well, may lead to cancer of the affected part (USDHHS, 2004).
Visual aid- I will use the picture of discolored teeth to explain the impact of smokeless tobacco.
Transition: Having looked at the effects of smokeless tobacco let us now summarize what we have learned.
Conclusion
Despite the notion that smokeless tobacco is beneficial, the effects it has on an individual are similar or even worse than those caused by smoking. This shows that, it is crucial for one to consider staying away from smokeless tobacco for one to avoid these disastrous effects. The disastrous effects are many but there is some hope in that if one stops using theses products he will have healthy and fulfilling life (USDHHS, 2004). Let us make the right choice and stay without either smokeless or tobacco for better health and good life.
References
Peate, I. (2005). The effects of smoking on the reproductive health of men. British journal
of nursing. Mark Allen Publishing Company. Pp. 362–366.
Scientific Committee on Emerging and Newly Identified Health Risks, SCENIHR (6
February 2008). Health Effects of Smokeless Tobacco Products.
U.S. Department of Health and Human Services. (2001). Women and Smoking: A Report of
the Surgeon General. Rockville.
U.S. Department of Health and Human Services. (2004). The Health Consequences of
Smoking: A Report of the Surgeon General. Atlanta.
http://quitsmoking.about.com/od/tobaccostatistics/a/cancerstats.htm
World Health Organization, WHO (2008). The Global Burden of Disease.
Here are the visual aids to be used.
Cigarettes
The cardiovascular blood vessel
An unborn child