A Vasoplegic Syndrome Case - 997 Words

Vasoplegic syndrome is a severe vasodilatory shock characterised by hypotension, tachycardia, normal or elevated cardiac output, decrease in systemic vascular resistance, poor or no response to fluid resuscitation and vasopressor administration [1]. Though it is commonly seen during cardiac surgery, it is also been reported during non cardiac surgery [2,3]. The incidence of vasoplegic syndrome is 8-10% in cardiac surgery [4], and its risk factors include intravenous heparin, beta-blockers, calcium channel blockers, renin angiotensin system antagonists, protamine use, myocardial dysfunction, diabetes mellitus, presence of pre-cardiopulmonary bypass hemodynamic instability, increased duration of cardiopulmonary bypass and ventricular device insertion [5]. We present a case of successful management of vasoplegic syndrome the developed perioperatively following Whipple’s procedure. Report A 76yr old 52kg male, was schedule for Whipple’s procedure for carcinoma head of pancreas. He was a known hypertensive of enalapril and poorly controlled diabetic on insulin. His preoperative investigations were unremarkable except of elevated HbA1C. The proposed procedure was planned under general anaesthesia with thoracic epidural, for which the patient consented. After instituting appropriate monitoring thoracic epidural catheter was placed in T7-T8 interspace before induction of general anaesthesia. General anaesthesia was induced with fentanyl 2mcg. kg-1 and propofol 2mg.kg-1, andShow MoreRelatedA Case Report Of Probable Vasoplegic Syndrome1482 Words   |  6 Pageshypotension in prone position is a challenge to anaesthesiologists and more so if this hypotension is complicated by non responsiveness to conventional therapy. This non-responsiveness may be due to vasoplegic syndrome. We cite here a case report of probable vasoplegic syndrome in prone position. Case report: A 52 year old male patient weighing 70 Kg, diagnosed with D9-D11 ligamentum flavum hypertrophy with canal stenosis was posted for laminectomy in prone position. He was a known hypertensive andRead MoreThe Concept Of Critical Care Nursing3148 Words   |  13 Pagesintegrate these sophisticated technologies and interventions to deliver competent, evidence-based and holistic care to critically ill patients (Morton Fontaine, 2013). The aim of this written assignment is to present an Intensive Care Unit (ICU) case of Diltiazem Overdose (Deliberate self-Harm) who was admitted in a large metropolitan hospital in New Zealand (NZ). Care provided to Mr. Jack (pseudonym) will be discussed and evaluated, with main focus on the nursing care delivered which contributed

A Monkey And His Disease - 1941 Words

A Monkey and His Disease The day of his death was a scary day. His arms turned blue and pale, had tubes going into them to keep him alive; His face turned almost grey but eventually, the disease won this battle. The death certificate said he died of HIV/AIDS complications at approximately 3:32 p.m. The knowledge of HIV/AIDS treatment has progressed over the past sixty years due to scientific advancements making Huxley’s quote: â€Å"But I don t want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness. I want sin,† negative to historical figures but positive to people who are living in the new generation. Finding the origins of AIDS in a chimpanzee traumatically changed society and ever since 1950,†¦show more content†¦This caused the defect of the human’s immune system, making it easier for any person with this disorder to become more susceptible to diseases that people with a healthy immune system usually will not get. Bette Korber created a model which estimated any virus ‘age but since HIV is an unusual virus because it changes its own DNA by mutation and recombination, they could not really find the origin of it which is also why it is so hard to make a vaccine for this virus which is why they only used this machine to find the oldest age of that strain. Ever since the discovery of this, it has been much of a huge commotion. This commotion has been so big, ever since the origin date came about; scientists have been finding ways to cure this disease. The tools created to make medicine for AIDS patients have been very helpful and important to society. Ever since tools were created to make medicine to reduce the symptoms of AIDS, doctors have been doing everything they can to provide patients with the correct care so that they can survive. Due to this, people have gone far enough to the point where they made medicine cheaper and affordable by insurance making it available for many classes of people. â€Å"We won’t see the end of AIDS,† says Gates, in terms of there being no cure therefore it’s not much of a point in not making the medicine cheaper. The tools to cure

Clinical Practice Reflection

Question: Discuss about the Clinical Practice Reflection. Answer: Introduction: Leadership can be described as a quality that influences the people for achieving any purpose or any set of goals. However, leadership and management are not the same and differentiating leadership from the management results in the origin of confusion in many cases. It is quite evident that all leaders can be good managers but not every manager can be an effective leader, hence, making the leadership a vital aspect of better and effective management (Chapparamani Jyothi, 2011). The work of various behavioral theorists provides insights into the democratic, autocratic, and laissez-faire styles of leadership, which impacts the organizational performance to a large extent. Despite the several conceptualizations based on the leadership, there are many authors that agree on the fact that leadership is a process, which includes influence, takes place in groups, needs an adaptive and goal seeking approach, as well as, occurs at all the levels. No doubt that leader are the ordinary people only who perform extraordinary things through the better use of power in formulating the future. Hence, this implies that the individuals as leaders are judged mostly by the consequences based on their behavior in spite of their physical characteristics (Thomas, Bellin, Jules, Lynton, 2012). This essay is basically a reflective essay based on the experience during clinical practice, which will reflect my own leadership qualities demonstration and development and the process that helped in analyzing the situation and implications of the leadership roles in the future. As we all know that nursing leadership compasses from staff nursing involved in caring the patient to the nurse who is an in charge of a hospital, the nurses should acquire the effective and appropriate leadership skills. Nursing leadership requires to be focused on the people, as well as, on the problem-solving ability in an ever demanding atmosphere of the health care system (Nazarko, 2004). Hence, with the use of Gibbs reflective cycle, I will reflect on the incidence of care that I was involved in during my clinical placement. As Gibbs cycle involves six different stages it will improve my learning from the situation I experience and will help in improving my nursing practice in the future. The Gibbs cycle involves the description of the situation, analysis of the personal feelings that I have experienced during the situation, evaluation of the overall experience I had from this situation, analysis of the situation, conclusion, and action plan which will prepare in case the same situation arises in the future (Black Plowright, 2010). Reflection is helpful in generating the practical knowledge, leads to the development of the self-esteem, helps an individual in assisting the abilities that will help in adaptation to the new situations, and generates satisfaction towards the professionalizing practice. It is the process of gaining confidence, improvement, self-awareness, and learning things from own behavior and mistakes that improve the future through the process of learning from the past (Gomez, 2014). Moreover, through the process of reflection one can have a good understanding of the things they do and what can limit our abilities, thus providing the opportunity for improving the way an individual can care in a health care system (Duffy, 2007). To use the situation for my reflective essay, I would not use the original personal details of the patient. To protect the patients identity, as well as, to maintain the clients confidentiality, I will address the patient as Joy, as according to the NMC code of professional conduct, it is the duty of a health practitioner to protect the information of the patient and should treat the information as confidential unless it is required for the given purpose with the consent of the patient ("Nursing Midwifery Council Code Of Professional Conduct", 2002). During my clinical practice placement, I once got a chance to assist a patient named Joy who was a 70-year-old man and was shifted from an emergency department. The patient was suffering from urinary retention and had a considerable pain. During his handover, my mentor and I were told that we have to take care of Joy on that shift, and were also requested to change the dressing of Joys right leg as his right leg was ulcerated due to the condition called as Peripheral Vascular Disease. Moreover, due to this disease, Joy also had an amputation of his left leg below the knee a few years ago due to which he was mobilized with the help of a wheelchair. It was quite evident during his handover that Joy was very difficult for the past two days. Further, the nurse in charge of the emergency department told us that he used to throw things across his room and used to press the nurse call button constantly and was shouting throughout the day. He had also denied changing his pajamas and didnt have a wash. After his handover from the emergency department, my mentor told me that we should now change the dressing of Joy but he should be first cleaned and get him changed and if I could assist her in that. We then gathered the required equipment from the treatment area and proceeded towards Joy's room. As soon as I entered his room, I saw that Joy was sitting on his bed and was quite tense. I then introduced myself to him as a stu dent nurse and asked his consent to assist in his washing and changing clothes. He looked and shouted as soon as he asked his consent. He said that he only wants to see the doctor and stated that he didnt smoke a cigarette for the past couple of days. I explained him very politely that I would be assisting in changing and applying the dressing of his right leg and prior to it he should have a wash, as well as, change his clothes. I then continued to engage him in the conversation by maintaining a slow and soft tone. Further, I asked him that should I send a cup of tea for him after the procedure. I noticed a change in his body language and he was softened in his language and smiled with the approval of sending a tea. I smiled and repeated that if he could allow me to assist in washing and changing clothes in a very polite and relaxed posture. Joy allowed me and I proceeded in maintaining the personal hygiene and cleanliness with dignity and respect. Moreover, with Joys cooperation w e were able to proceed with changing his dressing. Through this clinical practice situation, I experienced different feelings. As the nurse in charge created a negative picture of Joy during the initial handover and described him to be difficult, I wondered why the patient was so demanding and aggressive. I felt very nervous and anxious during the handover as it was the first time I was going to assist the patient directly and did not have enough experience of dealing with the situation. However, after meeting Joy I was clear about the reason why he was frustrated and angry. To my notice, I observed that there was no wheelchair in Joys room, and without a wheelchair, Joy was just confined to his bed, which led to the loss of his autonomy. Further, it was clear that Joy was a smoker and he was not put on nicotine replacement therapy for helping him to cope up with the withdrawal symptoms. Hence, the loss of his autonomy and inability to cope up with the withdrawal symptoms has made him feel frustrated and angry. On analysis of his sit uation, I also felt frustration for him and at the same time made me angry. From the situation, I evaluated that there was a breakdown in the development of the nurse-patient communication and relationship, which made the patient frustrated and angry (Evans, 2013). The communication skills and compassion of the nurse in charge was not sufficient for understanding the patient. She was not listening to the clients requests and was not showing an empathetic attitude towards the client, which is very much required for the development of a healthy therapeutic relationship amongst the two (Hodson, 2013). This incident enables me to self-examine and to find out my short fallings that I had to the incident. Moreover, I was able to associate theory to the practice through this incident. The foremost quality of a good leader is having good communication skills (McGough, 2007). Through this incident I realized that I had the communication skill as an outcome of communicating with Joy was positive and the personal hygiene goal was met. Self-awareness is considered to be the foundation of an effective management and is an important quality and skill required in leadership. To provide high standard care and improving the performance one must require management of the cognitive, behavioral, and affective self to engage the health care professional in therapeutic relationships (Pavlovich, Collins, Jones, 2008). It involves an understanding of own beliefs, motivations, thoughts, limitations, biases and recognizing their impact on the provision of the health care services. It is very necessary being a student nurse that there must be complete awareness of strengths, as well as, weaknesses (Martin, 2012). The incident made me realize that I was not comfortable in questioning the nursing care and should have acted in a more assertive manner as Joys basic needs were ignored. However, in the future I will be more assertive and will question if there is any bad practice or needs of patients are not carried out properly in the future, because as per NMC, the person is accountable for their own omissions and actions in the practice and one should always be capable of justifying their own decisions (Sutcliffe, 2011). The situation needed the implementation of the interpersonal skills, both verbal and nonverbal communication technique. Nonverbal communication can be described as the transmittance of information without speaking. Joys body language clearly indicated the anxiety and tension he was having and hence, approaching Joy with empathetic attitude ensured that his participation in the communication is appreciated and he was understood (Peate, 2009). Verbal communication was enhanced by utilizing the facial expression, as well as, paraverbal communication, which included pitch, tone, volume, and speed while speaking, hence communicating in a soft tone added more meaning and value to the words (Hofert, Burke, Balighian, Serwint, 2015). The participation in the clinical practice and through Gibbs's reflective cycle, Im able to recognize the way of putting the learning experience as a useful asset in my clinical practice in the future as a nursing professional. In case, I have to face the same kind of situation in the future, I learned that I require to show more assertiveness and should show the courage of questioning the attitude of the nurse at an initial stage as 'bad practice' is not acceptable. If I feel that the patients requirements are not fulfilled, my primary consideration must be the protection of the safety and interest of the patient as per the NMC Code of Professional Conduct ("Nursing Midwifery Council Code Of Professional Conduct", 2002). The nurse plays a vital role during the provision of healthcare services to the patient. The development of the therapeutic relation between the nurse and the patient is very important. By use of effective communication skills a good and effective therapeutic relation can be developed (Peate, 2009). From this experience and through this reflection, I learned that the use of communication skill is the most important and necessary skill for carrying out the care of the patient. Moreover, I was able to demonstrate the importance of ethical practice and one should always objectify if the needs of the patient are not met. Further, the development of effective communication needs as much consideration and practice as is required by other aspects of nursing (Disser, 2003). References Black, P. Plowright, D. (2010). A multià ¢Ã¢â€š ¬Ã‚ dimensional model of reflective learning for professional development.Reflective Practice,11(2), 245-258. Chapparamani, D. Jyothi, P. (2011). Review of Literature on Leadership and Leadership Qualities.IJAR,4(2), 7-9. Disser, A. (2003). The path from good to great for the nurse leader: Demonstrating the practice of nursing.Nurse Leader,1(4), 30-32. Duffy, A. (2007). A concept analysis of reflective practice: determining its value to nurses.British Journal Of Nursing,16(22), 1400-1407. Evans, D. (2013). The provision of health and social care services for older people by respite providers.Contemporary Nurse,45(2), 255-263. Gomez, C. (2014). Become a better unit leader through self-reflection, awareness.Recruiting Retaining Adult Learners,17(3), 9-9. Hodson, M. (2013). Compassion, Caring and Communication: Skills for Nursing Practice Compassion, Caring and Communication: Skills for Nursing Practice.Nursing Management,20(6), 11-11. Hofert, S., Burke, M., Balighian, E., Serwint, J. (2015). Improving Provider-Patient Communication: A Verbal and Non-Verbal Communication Skills Curriculum.Mededportal Publications. Martin, E. (2012). How self-awareness helps a physician become a leader.Clinics In Dermatology,30(2), 248-250. McGough, G. (2007). Communication Skills for Nursing PracticeCommunication Skills for Nursing Practice.Nursing Standard,21(17), 30-30. Nazarko, L. (2004). Developing skills to perfect the art of communication.Nurs Residential Care,6(1), 8-12. Nursing Midwifery Council Code Of Professional Conduct. (2002).Nursing Ethics,9(6), 674-680. Pavlovich, K., Collins, E., Jones, G. (2008). Developing Students' Skills in Reflective Practice: Design and Assessment.Journal Of Management Education,33(1), 37-58. Peate, I. (2009). Communication and Interpersonal Skills for NursesCommunication and Interpersonal Skills for Nurses.Nursing Standard,24(14), 30-30. Sutcliffe, H. (2011). Understanding the NMC code of conduct: a student perspective.Nursing Standard,25(52), 35-39. Thomas, R., Bellin, J., Jules, C., Lynton, N. (2012). Global leadership teams: diagnosing three essential qualities.Strategy Leadership,40(3), 25-29.

sanat sanat iindir Essays - Erine, Yaban, Nasl, Unun, Bayeux, Tpk

Sanat, sanat i?in midir, yoksa toplum i?in mi? 'Sanat, sanat i?in midir, yoksa toplum i?in mi?' Lise y?llar?m?zda, okullar aras?nda yap?lan m?nazaralar?n demirba? konular?ndan biri de buydu! ?ki taraf da savunduklar? teze uygun kan?tlar bulmaya u?rarlar; sonunda retmenlerden olu?an j?ri, taraflardan birini galip ilan ederdi... Bu ikilem, beni her zaman tedirgin etmi?tir. Sanat?n toplum i?in oldu?u sav?, bana birka? y?nden, 'Bedreddin ?zerine ?iirler'i, 'Do?u ?iirleri'ni ve 'Mustafa Subhi ?zerine ?iirler'i yazdm y?llarda bile, ikna edici bir tez gibi g?r?nmemi?tir. Bunun birka? nedeni var: ?lki, sanat?n t?pk? felsefe gibi, gayesinin kendi i?inde (ya da, kendine) olmas? gerekti?ini dn?yor olmamd?r. Daha ?nce de yazd?m: Felsefenin bir praksis olarak gayesinin kendinde oldu?u (eupraxia auto telos), ilk defa Aristoteles taraf?ndan ?ne s?r?lmt?r. Felsefenin gayesi, nas?l ki, felsefe yapman?n verdi?i entelekt?el haz idiyse, sanat?n gayesi de sanat yapman?n verdi?i haz olmal?d?r: Estetik haz! Do?all?kla bu durum, felsefeyi ve sanat? yapanlar i?in oldu?u kadar, onu al?mlayanlar i?in de ge?erli olmak gerekir. ?te yandan, sanat?n toplum i?in oldu?u sav?, antropolojik adan da sorunlu bir konudur. Nedeni ?u: Sanat?n estetik fonksiyonunun dnda bir gayesi olu?u, ancak sanatla zenaatin veya sanat?n b?y? ve din ile olan bir arada olu?una ili?kindir. Lascaux ve Altamira'daki ma?ara resimleri, insan?n avc?l?k ve toplay?c?l?kla ya?am?n? yeniden ?retti?i (ge?imini sa?lad) yaban toplumun ?r?nleridir. Ma?ara resimlerinin gayesi, avlama i?ini kolayla?t?racak b?y? objeleri olmalar?ndad?r;- daha fazlas? de?il! Bayeux hal?lar? da, orta?a? ?atolar?ndaki hava ak?mlar?n? kesmek gayesiyle ?retilmi?lerdir. Bug?n i?in bu gayeye y?nelik bir kullan?m fonksiyonu s?zkonusu olmad i?in, Bayeux hal?lar? sadece estetik fonksiyonu ile sanat objesi olarak m?zede sergilenmektedir. Sanat?n toplum i?in olmas? onun estetik (haz) fonksiyonunun ('auto telos'unun) geriye itilmesi, onun gayesi dnda kullan?lmas? anlam?nda, kullan?m fonksiyonunun ?ne kmas? demektir. Bir sanat objesi (mesela, bir ?iir, bir resim) toplum i?in ?retildi?i sav?yla ortaya k?yorsa bu, onun t?pk? ma?ara resimlerinde ve Bayeux hal?lar?nda oldu?u gibi, estetik fonksiyonunun geriye itildi?i ve kullan?m fonksiyonunun ?ne kar?ld anlam?na gelir. Buradan ?una var?yoruz: Naz?m Hikmet ve Necip Faz?l gibi b?y?k ?airlerin b?y?kl, onlar?n belirli bir ideolojik ba?lamda toplum i?in yaz?yor olmalar?nda, yani ?iirin kullan?m fonksiyonunu ?ne karmalar?nda de?il, ?iirlerinin kullan?m fonksiyonu g?z ard? edildi?inde estetik bir haz veriyor olmalar?nda aranmal?d?r. nk? ger?ekten baz? ?iirlerinin ideolojik g?ndermelerinin (mesela Naz?m'?n 'D?rt Mapushaneden' ?iirlerinde, ya da Necip Faz?l'?n 'Sakarya' ?iirinde) ?ne kmadn? s?ylemek m?mk?nd?r. Do?all?kla bu durum, Naz?m Hikmet'in ve Necip Faz?l'?n, ideolojik anlamda kullan?m fonksiyonunun g?z ard? edilmesi m?mk?n olmayan toplumcu ?iirleri i?in ge?erli olamaz... Dikkat edildiyse, Necip Faz?l i?in de 'toplumcu' nitelemesini kullan?yorum. 'Toplumcu' ?iirin, bana g?re elbet, dar anlamda 'sosyalist' bir ?iir olmas? gerekmiyor: Mesela Mehmet Akif de toplumcu ama M?sl?man bir ?airdir ve elbette sosyalist de?il! Belki de Adorno'nun s?yledi?i gibi, subjektif duygular? dilegetiren lirik ?iirler, kan?lmaz olarak bireyci ?iirler olmak zorunda de?ildir; lirik ?iirlerin de Adorno'nun deyi?iyle 'ideolojinin ?rtbas etti?ini aa kartma' gibi bir kullan?m fonksiyonu olabilir. Ama bu, 'aa karma'n?n, Heidegger'ci anlamda 'aletheia', yani, 'if?a etme' anlam?nda Hakikat'i imliyor olup olmad, ayr? bir yaz? konusudur.