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A Rose for Emily Literary Analysis
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A Rose for Emily Literary Analysis
Faulkner’s most famous and popular short story, ‘A Rose for Emily” is a story which evokes strong emotion through the use of a good blend of plot, character, setting and other literary techniques to enhance the effectiveness of the story as a whole. The main character Miss Emily Grierson’s deranged behavior elicits many questions on the mind of the reader regarding her mental faculties. On a whole perspective, the story centers on Emily who is deeply admired by the community which is defined as a tradition or a fallen monument. On the contrary, Emily is a person who has a very dark heart given the way she handles her lover. The act of poisoning and killing her lover shows that she has a dark heart inside. The story is an exposé on the life of Emily who is a character that is aristocratic on one part in addition to harboring secret unspeakable secrets. Different literary devices are used to enhance the effectiveness of the message by making it be delivered in an easily understandable form.
Setting
The theatre upon which the story is based is in and old house and in an equally old town. The setting is comparably rich in Faulkner. He creates his town to be the auditorium of his story. Mississippi Yoknapatawpha is the setting upon which all the action takes place where it encompasses the last living days of Grierson. Major of the action that unfolds in the story is based on the situations that arose when their way of life changed drastically making them more confused on how to change their life to incorporate a new cultural perspective. On the essence of the time setting of the story, the story runs from the time Miss Emily Grierson was born to a time when she died of old age. As such, the story covers over sixty years of the life of the main character. Major events unfold during those years as depicted in the story. For instance, some of the major events that dot the time frame include the short illness and eventual death of her father and the time she met her lover during the summer to be specific. It was at this time that slavery had just ended and the middle class was gaining relevance by the day. Emily and her family were rich and with lots of slaves. As a result, the story quite compares the traditional versus the nontraditional and the conflict of the old versus the new. After the death of Emily’s father, their life is bleak since everything that they once held close to their heart was changed in a moment. Her father meant a lot to her as evidenced by the emptiness of life that she had to grapple with after he left. She is left to figure life on her own. This contributed greatly to her madness and a poor sense of judgment. For instance, due to the controlling nature of her father, she found it hard to live with Homer. She felt that she needed someone to lead her again that eventually causing her to kill him. Additionally, the author effectively depicts how Emily thrives in a world of timeless vacuum and of her creation. Literary speaking, the story is a rich blend of setting as it richly unfolds in the life of Emily.
Symbolism
William used symbols in a way that creates meaning and emotion in the story. There are different ways that the author has used to symbolically represent different aspects of the story. One of the ways through which the author achieves this is through the use of metaphors and allegory. Emily’s house just like the owner is a perfect representation of a world which is dying around her. The house was built during and after the era of reconstruction that was in the 1870s. Southern aristocracy was slowly diminishing. The house is an extension of the life of Emily. For instance, it owes its, “stubborn and coquettish decay” to the residents of the town. It depicts the tradition of both fortitude and preserving the culture that was seemingly getting out of the town’s people. Emily’s ‘house is an emblem of alienation, mental incapacity, and eventual death. For instance, the author notes that it is a shrine which still thrives it its past .
The past is a slave of the present time. The house depicts the past life which Emily was not ready to leave behind. Just as the house is ugly on the outside, the inside is not very different. The inside is purely nightmarish. Literary is was a tomb. Through this, the story gains relevance in an ever-changing cultural landscape. Many residents of the town were fascinated by the house just like the owner. It was a fascination to many. It is evidenced to a time when they sprinkled lime on the foundation of the property which would, in turn, counteract the stench of the foul that emanated from the bedroom of Emily which harbored a dead man. It is a struggle to leave the past as evidenced by the author. The past is, therefore, a symbol of oneness and togetherness. Each of the town people has their interpretation of the happenings in the bedroom of one of their neighbors. Ultimately, the death of Emily represents a time when the residents of the town had the freedom to pore into the secret life of Emily and understand her wildest notions and logics upon which her thoughts were centered on. Effectively, it was upon them to break the realm of the past and embrace the future.
In addition to that, the strand of hair is a symbol of love and the tricky things that people engage in in the pursuit of their happiness. Consequently, a strand of hair is effectively used by the author to remind of lost love. Moreover, it reveals the inner life of a woman who is committed to living life as defined by her way of thinking without the influence of the society and neighbors in general. She did not live with the approval of others. Symbolically, the strand of hair is an emblem of a person who undergoes a struggle of subscribing to the status quo. Emily lives in her world where she is not easily influenced by the definition of others, and it’s very shocking considering her definition of life. The narrator effectively uses foreshadow to symbolize a life of transformation as she passes through life. As a symbol of aging and change, the story shows how life has changed over time. Her hair grows changes slowly until it becomes a “vigorous iron-gray”. It is a representation of the fragility of life. Her hair becomes more grizzled as she ages.
Motifs
A motif is an idea or image that is recurring thus helping to develop the theme in a piece of work. Eventually, as seen in the story, this is achieved in through different ways. One of the major ways this is achieved is through the recurrence of ideas and images. The dust has been consistently used by the author to show the decay and decline that prominently takes place in the story. The dust as it is depicted by the author is in a perfect accompaniment of the life of the residents as it fades into uncertainty. For instance, when the elected city council members come to secure Emily’s annual tax payments, her house has a unique smell which resembles that of dust and disuse. It is an air of unconditional change and periodic laxity. Dust collects as the aldermen frequently move around the room. As it rises, it obscures the men from understanding the kind of life as envisioned by Emily. The dust serves to protect the main character of Emily from the men. As a result, the men cannot understand the relationship that Emily has of obscurity in the face of uncertainty. The true nature of Emily does not come out clearly since the presence of dust is oppressive. Despite being everywhere, it is more ominous here given the magnitude of the current situation.
Another motif that is prevalent in the story is the act of watching. The author of the story has used this motif to amplify the importance of the changing nature of events in the life of Emily. Emily is under intense scrutiny from the narrator and the general public. Consequently, the life of Emily undergoes a multifaceted and intense speculation from the neighbors. The towns’ people are often interpreting the life on one of them despite having little knowledge of her. Attending her funeral in full glamor of respect and honor show that the intention of the people is to satisfy their inner curiosity of the woman underscores the main point of loyalty to their own. However, despite all the scrutiny, they never get close to knowing the true nature of Emily’s life in any perspective. As a result, Emily becomes a figure that is observed only from the eyes of onlookers with a vague picture of reality. The author has succeeded in making the true nature of Emily a mystery to the people of the town. As a result, the story creates a feeling of emptiness and that of satisfaction on the mind of the reader. She is an idol of admiration and anonymity. Despite giving clues, she is a secret. They don’t grasp the true identity of Emily. It is only after she is dead that her true identity is revealed (Vanhelleputte, 16).
Irony
Irony’ Irony is prevalent throughout the text.one of the prominent instances of irony in the story is that of Emily claiming to loving Homer. Instead of death separating them, it forms their union. This is ironic. She murdered the man she loved to create a bond that lasted through eternity. Situational irony is where something happens in a story that is quite the opposite of what the reader expects. In the story, the reader does not think that the dead body of Homer is packed in the house. Following the death of Emily’s father and the hardships that follow, she is still well revered in the community. She is considered an upper-class citizen. Once Homer moves into the town, he begins dating Emily. He represents the north during the civil war era. It is ironical that Emily accepts a man with a very different cultural background into her life. Love is a beautiful thing that surpasses thoughts and traditions. Emily knows this too well and would like to experiment on it. She is not expected to court a man of that social background. The type of irony, in this case, is referred to as situational irony. It is very ironical given the turn of events. Faulkner effectively utilizes this device to bring about an air of uncertainty in the story. Effectively, this strengthens the relevance of the message. When something completely frustrates the expectations of the reader, it is a shift in the plot of the story. Shifting the story consequently brings about an insistence on a major theme. As a carpetbagger, he was not expected to court one of the most revered women in the town. The irony of the situation is that the Southerners were only expected to marry the southern men (Muecke). He broke out of this cocoon and ended up with a woman with deeper desires than he would provide eventually.
The narrator effectively exemplifies the use of the pronoun “we.” This effectively creates a different picture in the mind of the reader by incorporating all the thoughts of the people of the town. She is thus given the idea of a heroine. A collection of images is thereby created, thus creating a communal thought on a perspective. Effectively, the narration successfully creates a notion of communal consciousness and peculiar sapience. Being the only point of focus causes her to be the main character amidst the multitude of people with different vested interests. The narrator contributes to the development of the plot by impacting on the overall objectivity of the story. This is because, despite the first narrator speaking as a single narrator, he speaks on behalf of the people of the big town. Unity and togetherness are witnessed here. Consequently, the story takes an impersonal approach. Making it impersonal creates an air of imbalance since the reader is left to read the story in a multifaceted approach.
Effectively, the plot moves forward thus instilling more interest in the mind of the reader. The reader is thus left to make assumptions and thoughts. The author was objective in using the first person narrator and thoughts in the story. A major unexpected twist of events takes place at the end of the story. The author knew perfectly well that the end of the story would make all the difference. A difference not seen by the reader even without making guesses. The nature of Emily’s life is full of mystery and darkness. She us the only one who knows her deep longings which she cannot share with anyone. There are many ways of fighting hopelessness and she knew none of it. This effectively exemplifies the nature of Emily’s life. This creates an impact that is powerful encompassing the whole story.
The story is not driven by events. Instead, they whole point of the plot of the story is to reveal the character of Miss Emily and the circumstances of her life. For instance, she runs of from the people who are sent by the authorities to ask her to pay her tax. When the men come sprinkling to counter the horrible smell, she is seen watching them from a distance. The story is a reactionary story driven by circumstances quite contrasting the common nature of stories that are action driven. It is not sequential. Most of the actions that she makes sparks interest in the interest of the town’s people. On the other hand, the people of the town are left to explain the kind of life one of them is living. Her actions are simply for sparking interest in the minds of the people of the town. The story has been effective in detailing the life of a selfish and lonely woman. The use of motifs, imagery, irony blended in a perfect setting effectively conveys the major themes in the story of change and death. Death looms throughout the story. This is brought to life by using literary devices which effectively pass out the message in the story.
Works Cited
Muecke, Douglas Colin. Irony and the Ironic. Vol. 12. Taylor & Francis, 2017.
Vanhelleputte, Michael. “The Concept of Motif in Literature: A Terminological Study.” The Return of Thematic Criticism(1993): 92-105.
BMGT-110-Final-Paper-Kellys-Sandwich-Shop-Case-Study
Case study
The purpose of this paper is to identify how different factors effect on the growth of small businesses. The growth of small businesses has been influenced by factors such as growth strategy, business forms, short and medium term goals, financing assistance, organizational structure and staffing needs, customers and promotion, and ethics and social responsibility. In this paper we are going to discuss how the different factors alter the advancement of small businesses.
Kelly’s sandwich concession has been selling sandwich and other lunch items to her customers for the past five years. Though small, her business has been a very optimistic and fast growing business. Applying different strategies to aid in the development of the business has made a very big positive impact on it. In fact it is said to be one of the best in town. The business has developed from a small business, through using bicycle-towed concession that travels to different strategic locations in town, and currently she has got a restaurant where she can do her business from.
Kelly’s Business being a small business that is still growing faces some several challenges. The particular status of the business is examined at length in this document and several problems were discovered. This paper will be based upon the details provided by the content and it is separated straight into a pair of portions. The first segment looks at a number of causes of the down sides at the moment facing this Kelly’s business. The next segment offers suggestions that could allow Kelly to be able to address the difficulties she is facing so as to make her business even better.
Reasons why Kelly’s business is doing well
Kelly’s passion as well as skill for producing dependably refreshing, yummy lunchtime fare well-liked amid a company customers, largely workers as well as shoppers, has made her little business the thriving achievement. Through her skills, she has made her products popular with employees as well as other consumers.
Kelly’s strategic framework
Tushman along with O’Reilly outline proper wording as about three essential elements which guide supervisors realize the particular options in addition to restrictions which lie before their particular businesses. The elements tend usually are: environmental surroundings that the business performs in, the particular sources of their resources, in addition to a history on the business. The proper wording is the critical first part of Tushman alongside O’Reilly’s congruence product. Once the proper wording is usually comprehended, strategic alternatives might be created, vital chores described, in addition to place examined among people vital chores and also the organization’s men and women, organization, in addition to lifestyle. In case which proper wording is usually changed, nevertheless, alternatives might be incorrect, vital chores away concentrate on, in addition to interactions out of alignment. Kelly’s ideal circumstance has been through stunning improvements lately. Its aggressive surroundings, the customers, the marketplace situation, and its record are blended to change the proper framework.
Kelly has used several strategies to ensure that her business is well known to the consumers. First, through her passion and talent, she has made sure that all the customers near her concession know her lunchtime menu as the best in town. She has gone further to introduce a bicycle-towed concession to reach out to the customers who are outside walking distance from her business. This strategy has made her business grow even further. Kelly has advertised her small business through facebook to ensure it reaches as many as possible. The probability of achieving profitable growth is heightened whenever an organization has a clear growth strategy and strong execution infrastructure.
The main reasons for this small success in business growth are:
Inadequate consideration of opportunities within the core business, adjacent to the core business or within new customer sub-segments.
An organizational infrastructure that cannot support successful execution.
When any business develops, there is a predictable procedure of how things happen. For a business to achieve its goals and develop, there are several factors which should be taken into consideration. They include:
Sales
Each time a business evolves, finding revenue is usually every little thing. The actual promoting department uses the majority of management’s efforts.
There are several strategies managers can employ to increase the probability of success of a small business and Kelly being the manager of her business should take them into account.
Initiate a process to identify strategies with a high probability for success.
They include: Increasing the particular core enterprise, increasing by sub-segmenting buyers and also increasing nearby opportunities. It is strongly recommended that the chief leaders start the procedure by considering the progress likely from the found core enterprise and/or the particular opportunities and also progress likely connected with creating revolutionary price propositions at under functioned buyer organizations.
Strengthen the actual performance national infrastructure
Strengthening the performance of her business throughout the town and in the suburbs can make her business returns even more pleasing, using adverts and strengthening the sales and marketing team is also one of the key factors to her business success. In addition, hiring professionals, though it may be expensive for her business, in the long run can give her business a strong base to make her business a success.
Business form
A business form will make sense to Kelly’s business as it is undergoing expansion. In the form she should consider all the risks involved in expansion as well as the inputs and methods used to ensure the business prospers even better in the new environments.
Financial assistance
Through the equipment Kelly is using, we notice that she has financial constraints which can be addressed to ensure that her business gains a strong market share, not only in the town but also outside.
Kelly’s growth prospective will need be prepared for as well as obtaining suitable varieties of additional money, and this can be a key side to side design operating all through quite a few small enterprises. There are several sources of finances which aid in the growth of small businesses. They include but not limited to: grants from government, loans, and personal savings.
ORGANIZATIONAL STRUCTURE AND STAFFING
ORGANIZATIONAL STRUCTURE
The type of organizational structure that a business may use is determined by the type of business and the environment that it is in. Task allocation, supervision and coordination and goal achievement are all aspects to consider when designing an organization structure for a company. While some organizations may use hierarchical structures, smaller businesses may opt to use a more informal system. For example, Kelly’s business has the owner, Kelly, who also functions as the operations manager. As the business grows, managers may be added to supervise staff in specific areas of the business.
STAFFING
To determine staffing needs, businesses could use career operations to spot the particular varieties of abilities needed for each position. Period estimates as well as supplies necessary for each career ought to be described, along with the level of ability essential. Kelly’s business needs more staff as it goes through this time of upgrading and as we have noticed, she has considered hiring professional business consultant to assist her in her strategy of expanding.
CUSTOMERS AND PROMOTIONS
Customers are the kings in a business. For it to prosper, the managers of a certain business should make sure that the customers get value of their money as well as motivating them to be loyal to the business. For this reason the Kelly may use several promotions as incentives to the customers
The promotions include
Seasonal reduction of price. This works well in motivating the buyers to buy more.
Personal selling involves direct personal interactions between a potential buyer and a salesperson. Personal selling can be a powerful promotion method
Advertising in business is a form of marketing communication used to encourage, persuade, or manipulate an audience to take or continue to take some action.
5. ETHICAL ISSUES AND SOCIAL RESPONSIBILITY
5.1.1. Ethical issues
Integrity and believe in
A rudimentary perception of integrity incorporates the concept of doing your company affairs together with loyalty plus a motivation to be able to treat each consumer well. As we may notice Kelly is much sensitive to her relationship with her customers, employees and the community in general.
Diversity issues
The world is a rich and diverse place full of interesting cultures and people, who should be treated with respect and from whom there is a great deal to learn. An ethical response to diversity begins with recruiting a diverse workforce, enforces equal opportunity in all training programs and is fulfilled when every employee is able to enjoy a respectful workplace environment that values their contributions. . ( HSBC Group,2011) As Kelly thinks of expanding her business outside the town, diversity is a challenge she should address through hiring people from different places to counter this issue.
Decision making issues
Honorable decision-making procedures ought to target guarding member of staff and buyer rights, ensuring most enterprise functions are generally reasonable and just, guarding the most popular excellent and ensuring personal values and morals regarding workers are generally guarded. (Santa Clara University, 2013). Kelly as we can notice is careful when dealing with her employees as they are key to the success of her business.
Government compliance issues
Companies are likely to fully stick to the environmental legislation, federal government and also point out protection restrictions, fiscal and also personal exposure statutes and also just about all suitable municipal rights legislation.
5.1.2. Social responsibility
Small businesses have various social responsibilities which include: recycling of waste materials, reducing the energy consumption, establishing a foundation, volunteering in the community, offering help in global causes and collaboration with other businesses.
6. SUMMARY
There is a correlation between how growth strategies are employed in a small business and the consequent development of the business. Businesses engaging in social functions as well as practicing ethics make them grow even further.
Complying with the government rules is also important in the well-being of the business.
References
The role of exports in small business growth and job creation hearing before the Committee on Small Business and Entrepreneurship, United States Senate, One Hundred Twelfth Congress, first session, August 11, 2011.. (2012). Washington: U.S. G.P.O.
Aaker, D. A. (1984). Developing business strategies. New York: Wiley.
Moon, C. (2001). Business ethics. London: Economist.
A Road Accident Case study
A Road Accident Case study
Ryan should be in triage 2. This is because of the fact that patients in this cadre are critically ill and therefore demand medical attention within 10 minutes or else their situation will degenerate into more complicated forms. In most cases, these patients are normally brought to medical facilities by emergency ambulances.
In Ryan’s case, he is complaining of chest pains and has become notably shorter of breath and distressed on route. From these observations among others, it can be suspected that Ryan may be having a right sided haemothorax.
Also, Ryan should be in this triage because of the mere fact that he got retrieved from the accident scene by the Emergency Ambulance team half an hour after the accident had occurred and from this, he could be deep pain hence necessitating the need for immediate medical; attention without fail.
Haemothorax can degenerate into a situation where the accumulation of blood will start to exert pressure on mediastinum and trachea. This will strain the volume of blood that the ventricles of the heart are able to fill. Subsequently, this will further affect the trachea deviating to the unaffected part. This is what explains why Ryan should be in triage 2 where he is guaranteed medical attention at most within 10 minutes.
Priorities for care for Ryan
From the information given about Ryan’s situation, the first priority will be containing the chest pain, stabilizing breathing ability and nursing any injury sustained in the accident both seen and unseen.
The chest pain and breathing inabilities could be a result of haemothorax which is right sided. Because of the dire dangers of these condition posses to the patient, immediate and decisive measures are needed that they can be limited and thus saving the already threatened life of the patient.
First, it will be very prudent to remove the part that that causes bleeding and drain any blood and air that is in the thoracic cavity and the chest area. This is accomplished through the process of inserting a thoracostomy tube into the chest cavity and thus resulting in the expansion of the lungs thus preventing further bleeding.
While executing the above process, the danger of blood clogging in the tube is eminent. Therefore, to achieve effective and intended results for Ryan, better and effective drainage tubes are a necessity when draining the blood and air that might be in the chest cavity.
As earlier stated, the priority for Ryan’s treatment is to get him stable, stop any internal bleeding and drain blood and air from the bleeding and drain blood and air from the pleural cavity and also examine his entire body to establish whether there could be other hidden injuries that can pose a danger to hi healing process or at worse even his life.
A chest tube shall be inserted through the wall of the chest and made to drain the blood which is a result of draining and also air that could be in this cavity.
In situations where haemothorax may be complex and established that a tube alone can not mitigate the oozing blood, thorascomy or surgery option may be explored. This will be administered with the sole intention of controlling and deterring the bleeding that could potentially worsen the situation. Therefore, for him to regain the lost blood that is highly needed for his recovery, proper diet especially on green vegetables and any other food that is rich in minerals is a must.
From the description of the whole accident that Ryan got involved in, it was a grisly scenario that must have left him in a shock. Therefore, Ryan also needs some professional counseling that will accompany other therapies so that he can regain his usual self. Though the time that the counseling can be done may be in contention, but it is a necessity for him to receive it and the earlier this therapy can be administered to him the quicker
Another priority of care for Ryan shall be, identifying the genesis of the haemothorax and free treating it. In Ryan’s case of accident, a tube is what is needed though surgical operation can be explored in situations of further complications.
Ryan’s quick recovery can also be a top priority for the nurses attending to him. This can be achieved through a careful and systematic approach that can hasten his healing process without necessarily compromising its quality.
From the observation, Ryan has also sustained bruises especially the one that could have been caused by a safety belt. Such bruises if left unattended could also be a source of discomfort to Ryan who is also reeling from chest pain, breathing problems and even shock form the accident. Therefore, an emergency way of dressing such bruises can also be another priority Ryan also complains of nausea. This could be that when the TV flow. IV flow is higher chances are very high that the patient will vomit. Therefore in Ryan’s case it could be better if the IV flow can be adjusted so that he doesn’t vomit. This will further weaken him.
If an operation has been carried on Ryan or the point at which the drainage tube was inserted must be dressed. The dressing should be conducted to prevent any infection to the wound. The material chosen for such dressing should be of quality so as to promote faster healing
Also, another priority for Ryan will be the dressing on the wound that ought to be changed when: the wound is not dry and intact. This situation can be attributed to; symptoms of infection or any other worrying tendency like, example redness of the wound, swelling or discharges or no evidence for routine wound dressing after every three to seven days.
It must also be emphasized that dressing of wound should be done carefully and in the right way to avoid further complications from the wound which can affect his recovery path can be
Finally, the health priorities for a patient like Ryan can be many. However, compromises have to be made so as to ensure that the primary priorities for such patients are first addressed before other issues are dealt with. All these measures will be aimed at promoting his healing process while at the same time deterring the possibility of further complications from his conditions.
Pathophysiological events and nursing consideration
Hamathorax is contained first by removing the part that causes bleeding and draining any blood that might be in the thoracic cavity. Through the process of tube thoracostomy, blood in the cavity is drained. This is done through the insertion of a chest tube thus subsequently, affecting the lung to expand hence stopping the bleeding.
To prevent chest clogging or occlusion which potentially can lead to further complications like crippling effective drainage of the space in the pleural cavity, better performing chest tubes are a must.
Large diameter tubes or more than one tube are normally used with an intention of limiting clogging potentials and should clogging be detected, the patient always must transferred to a theatre with an intention of opening up the chest through a surgical process in order to get rid of pleural cavity clot.
In an event that the clot persists in the chest tube that is being used to drain the blood and any air from the chest cavity, or in the pleural cavity, Thrombolytic agents are applied to break this up. Though this can be an effective way of dealing with blood clogging, it does pose a risk in that it can result in increased bleeding as a result of the thrombolytic agent that makes blood less thick thus causing over bleeding
In circumstances as listed below surgical operations shall be explored so as to reverse the trend of blood being less thick. These circumstances are;
First, if there is continued bleeding from the chest, a condition that can be explained a 150-200 ML/h for two to 4 hours
Secondly, if back to back blood transfusion is needed so that to maintain the haemodynamic stability in the body.
When draining blood and air from patients with a coagulopathy, great care and attention must be paid.
This caliber of patients includes those patients who are normally administered with anticoagulation therapies whenever need arises.
At this stage, it must be noted that needle aspiration are not applied in an event where clotting deficiencies are prevalent. Instead, tube thorascomy is applied with a capability of visualizing and managing any bleeding from the chest wall. Out of necessity for patients who are in need of extended anticoagulant medication, such treatment mode can be re-continued after 8-12 hours after the thoracostomy has been done.
With the completion of tube thorascomy process, repeated chest radiographs should follow immediately. This will aid in the observation of the chest tube position hence assisting in observing how the exercise of evacuating the haemothorax from the chest cavity has been done. It may show other intrathoracic pathology that had been obstructed by the haemothorax.
Normally, a chest tube is placed to a water seal when the lung has been fully expanded through radiography. The drainage of fluid is usually less than 50ml within 4 hours and in these circumstances, residual air leak is limited.
There could be circumstances where a chest tube ought to be clamped. After the realization that air or liquid collection is absent through conducting follow up observation by use of radiography, the tube is removed. Also it is important that radiography is done after the removal of the tube to be certain of the absence complications should drainage be incomplete as shown by radiograph studies after the removal of thorascomy chest tube, a second tube should be done through the use of video-assisted surgery. (V.A.T) and a further operation conducted to completely drain the pleural cavity.
Research has shown that 70-78% of patients with traumatic haemothorax usually get successful treatment through the use of theroscomy chest tube and therefore such patients demand no further therapies apart from one to three follow up chest radiographs within a span of 2-5 weeks to be certain of absence of intrathoracic collections that can degenerate to further complications.
Additional chest radiographs may be necessitated by the prevalence of other intrathoracic pathology besides other symptoms. Extended treatment will be dictated by the extent other injuries.
Research has shown that nearly 20% of the individuals who have undergone tube thorascoscomy will register amount of clot in their thoracic space. Although this is a grey area on what ought to be done, a number of opinions have been fronted on the best way of addressing this. These opinions do range from the follow ups after the initial process to evacuations through surgical methods.
Video- aided surgery (VAT) has tended to be the modern trend of addressing this medical malady. In some cases, it is administered within 7 to 8 days after the initial injury whereas others perform it within 2-3 days after retained clot has been noted in the chest cavity
In situations where VAT is applied, one- lung ventilation is not a necessity. Instead one lumen tube is used to aid in ventilation during the whole process of operating the chest cavity.
Should cardiac, injury be noted, thoracotomy process should be reverted to and with speed so that further complications can be avoided.
The decision to employ VAT when dealing with retained clot is performed by the need to reducing the number of individuals who develops empyema and fabrothorax.
This process besides adding operative way of managing a patient, it does also provide an almost occurrence treatment mechanisms and decreasing the number of days that a patient needs to stay in the hospital unlike other methods.
After thorascomy or VAT on those patients that generally like other patients because of diminished risks chest tubes is removed when drainage is about 25-50 ml.
After the removal of the chest tube, chest radiographs are taken to be sure that the healing process is on course as intended and no further complications are noted and if any, adequate measures are take. Additionally, chest x-ray films can be obtained to enhance proper view and understanding of the whole healing process.
Haemothorax as a result of injury to the chest can be very tricky when handling it. It is therefore important that patients suffering from haemothorax when being treated are handled with utmost care.
This is what calls for utmost pathophysiological process and nursing consideration so that they can well be treated and timely healed where more than one treatment and timely healed. However, in some situations like retained, clotting where more than one treatment option exists, there ought to be an open approach to such an issue. This can be addressed through a more researched and a well versed option instead of applying options whose efficacy has not been tasted. In away, this will be a necessity since the issue at hand is the life of a human being that is hanging on balance and must be treated at all cost with utmost care.
Nursing management program for Ryan comprising relevant ED pathways and pharmacological management in ED:
It is apparent that Ryan is in a sorry health state and thus in dire need of emergency nursing measures. These measures will be directed to cardiopulmonary stabilization with an intention of limiting ventilator time and deterring sit upright unless other injuries hampers this position. Oxygen will be administered in order to give the patient breathing stability and air way should be released together with the breathing.
Because of Ryan’s conditions like, chest pain notably breath shortness, chest pain among conditions, there will be urgent need for his upright chest radiographs to be obtained so as to ascertain the extent of injuries to the chest and any other vital organs of the body. The aim of this is to establish the extent of the injuries and the most appropriate treatment to be adopted when treating the patient,
An extensive evaluation of the chest ought to be done to establish whether tension pneumothorax is prevalent and if so, appropriate measure adopted. To be sure of this, needle decompression of tension pneumothorax shall be used. If it is confirmed, emergency measures shall be undertaken to diffuse it otherwise it can lead to worse oxygen shortages and very low pressure of the blood subsequently resulting to sequelae ( a condition that is a result of trauma or injury) which can actually cause death
Given that Ryan has exhibited respiratory complication, a thorascomy shall be needed. As explained earlier, thorascomy involve insertion of chest to be to the chest cavity so as to draining any blood that might be in the thoracic cavity. The tube inserted will affect the lungs to expand thus preventing further bleeding.
If it is established that Ryan has sustained bruises especially the one caused by a seat belt, measures like application of liniment shall be undertaken so as to alleviate any pain caused by such bruises that results from accident.
If needed be strong pain killers can be administered so as to mitigate discomfort to Ryan who is also suffering from haemothoraxRyan is in pain majority form the chest and through needs emergency pharmacological management in the emergency department so as to alienate this significant pain management aspects have been derived so as to assist patients like Ryan who are in dire need of them.
A number of tests must be done on Ryan to establish the extent of the injury to his chest. These tests include chest X- rays, Chest X-rays CT scans, pleural fluid analysis and thoracentesis
Emergency measures must therefore be undertaken on realizing that included Ryan is suffering form the already suspected haemothorax. The major target fro such treatment will be to make him (Ryan ) stable hinder further internal bleeding and also getting rid of the blood and air that might be in pleural cavity.
A chest tube will have to be inserted to the chest cavity through the wall with a sole purpose of draining blood and air in this space.
If it is found out that the haemothorax is advanced, a surgical method (thorascomy) will have to be applied so as to aid in controlling further bleeding. There is a likelihood of blood in the chest cavity to thicken because of activation of clothing cascade.
Blood thickening will lead to clots in the pleural cavity resulting to chest tube occlusion. Subsequently, this will effect inhibition of proper drainage of the pleural fluid. Therefore, effective working chest tubes are needed in order to limit the clogging potential and its related complications.
Ryan must be administered with 100% oxygen through non-re breathen mask. This shall aid him in breathing having been noted to have breathing Complication
Another emergency response that Ryan desperately née is the completed examination of his body to be sure that all injuries sustained in the accident are attended
It appeared that Ryan is only complaining of chest pain and that there are no other physical injuries , But a through examination of his entire body is a necessity otherwise if this is overlooked , a serious health issue could be underway that can greatly affected his healing process or even his health
Another emergency that might be needed for Ryan’s the use thrombolytic agents. These are used in situation where there are blood cloths. They are therefore used to diffuse clots in tubes or when such clots emerge in the pleural cavity. However, such procedure in risky because of the potential of leading to increased bleeding
In case bleeding persists, surgical operation will be a necessity especially if it has been caused by aorta rapture.
In summary pneumothorax is a bit common in trauma patients and therefore being able to promptly recognize the clinical aspect and also being able to aggressively care for the patient is of utmost importance. Therefore emergency departments (EDs) must have the necessary manpower with the best equipments so as to be able to fix such life threatening issues otherwise if left unattended; the life of a patient can be lost.
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