Respiratory Disease Patient Assessment

Respiratory Disease Patient Assessment Total Patient Care Patient Profile Name of patient: Miss Cheung Sex/ Age: F/ 17 Hospital/ Ward. Bed no.: Alice Ho Miu Ling Nethersole Hospital (AHNH) / E4 (Paediatrics unit) / 25 Demographic Data (Client’s personal particulars) Psychological assessment: Miss Cheung, 17 years old, was born in Hong Kong in 1996. She speaks in Cantonese. She is a student and studies in secondary six. She is single and lives with parents at Tai Po. She has no religion. She is a non-smoker and non-drinker. Miss Cheung is shy when people talk to her. She expressed that she does not good at communicating with people. She hoped that she can return to school as soon as possible. Admission Details: Past health history: Miss Cheung did not get respiratory disease before and with good past health history and no family disease history. She has no known drug allergy and food allergy. Reasons for admission/ chief complaint: Miss Cheung was admitted to AHNH E4 ward from the Accident and Emergency Department (AED) on 1st December, 2013 at 11am with her mother for chief complaint of fever for 5 days which was up to 39.1oC, cough with yellowish sputum with small amount, mild runny nose and sore throat. She got fever which was 39.5oC with mild chilis at the time of admission. She had seen private sector for few days ago, but the condition had not been relieved and even worst with increased coughing and sputum production, persistent fever, runny nose and sore throat. Medical diagnosis and investigations: In the physical assessment, her neck was soft and no enlarged lymph nodes. Throat had mild congested without ulcer or exudates. Heart sound was normal with no murmur. Abdomen was soft, non tender, no mass and organ-megaly, and bowel sound was normal. Skin was intact and no rash. Chest X ray was done which showed that left lower zone had mild haziness but bilateral costo-phrenic angle were sharp. She was diagnosed as left sided pneumonia. Client’s progress (since admission, any examination, medical management, nursing care and client’s response): On 1st December, 2013 (admission day), her blood pressure was 114/60 mmHg, and SpO2 was 97% in room air which were normal; pulse rate was 128 beats per minute indicated tachycardia and respiratory rate was 22 breaths per minute indicated tachynea. Miss Cheung was diagnosed as left sided pneumonia. She complained of cough with increased sputum production, runny nose and sore throat and Actifed was administrated as prescribed. She got fever (39.5oC) with mild chilis, hence, Panadol and Augmentin were administrated as prescribed. She can continue diet as tolerated but she decreased diet and fluid intake due to loss of appetite and nausea. She got once vomiting with undigested food and yellowish fluid. Nasopharyngeal Aspirates was preformed for viruses detected. Sputum was collected for culture and blood sample was collected for complete blood count, renal and liver function test, C-reactive protein and AP titire. On the 2nd December, 2013, Miss Cheung complained of cough with increased sputum production but difficulty in coughing out, runny nose, mild headache, nausea and vomiting without abdominal pain and Actifed was administrated as prescribed. She got fever (38.8oC) and Panadol and Augmentin were administrated as prescribed. Miss Cheung complained of having loose stool in the morning which suspected the side effect of taken Augmentin. Miss Cheung had decreased diet and fluid intake due to loss of appetite and nausea. She got once vomiting with undisgested food and yellowish fluid in the morning Investigation(s) done: e.g. CXR, OGD Physical assessment date: Laboratory findings: Medication: Regular medication including oral and intravenous injection: Medications (when necessary): Comprehensive assessment using Gordon Functional Health Pattern: (Data collection date: 2nd December, 2013) Health perception and management Miss Cheung is a non-drinker and non-smoker. She has no known drug allergy. She had regular body check from the government health program. When she felt sick, she usually visited doctor immediately as she did not want to affect her study. She can indicate the rule of healthy life including regular exercise and balanced diet but she had not obeyed and taken action because of heavy schoolwork. Although she knew she was overweight, she cannot control herself on eating snacks. Nutrition and metabolism Miss Cheung has no known food allergy. She liked eating meat and fried food in which she ate fried food twice a week. She disliked vegetables and fruits, hence, she ate rare vegetables each day and fruits once a week. She usually ate 3 meals each day in which she usually ate noodles with egg and hams at the breakfast; fast food at lunch and rice with meats in dinner. She drank 6 cups of fluid everyday including water, soft drinks and soup. She ate snacks including chocolate and potato chip at most recess time. She decreased diet and fluid intake 5 days ago due to loss of appetite and nausea. Elimination She reported that she usually got 6 times urination everyday in which the urine color was yellowish with no pain and burning sensation. She usually had bowel elimination three times a week with brown and formed stools. But she complained that she got a loose stool on 2nd December, 2013 morning. She got once vomiting on 1st December, 2013 and once vomiting on 2nd December, 2013 morning with yellowish fluid and undigested food. Activity and exercise Miss Cheung does not have regular exercise but usually goes shopping with her friends about 5 to 6 hour at weekends. She prefers watching movies and playing computer games in the leisure time. She complained that she became weak and easily felt tired started five days ago. When she walked for a while, she felt shortness of breath. As she got the PE lessons on the 29th November, 2013, she coughed even worst and had breathing difficult and felt better after taking rest. Cognition and perception Miss Cheung is fully alert, and conscious, oriented to time, place and person. Her speech is clear; vision and hearing is normal and her response is communicable. She complained of headache and sore throat. Sleep and rest Miss Cheung expressed that she usually has 7 hours sleeping hours from 12am to 7am at night and usually sleeps well but sometimes get nightmares. She complained that she had decreased sleeping quality five days ago as cough became worst at night and sore throat which disturbed her sleeping. She reported that she cannot sleep well during hospitalization because of the strange environment and coughing. Sexuality and reproduction Miss Cheung is single and never has sexual activity. She does not have regular self breast examination and genital examination. Roles and relationship Miss Cheung lives with her parents and has good relationship with her parents and always gets support from her parents. She feels satisfactory on her social life and has good relationship with her friends. She expressed that she missed school life and her friends and hoped that returned to school as soon as possible. Self perception and self concept Miss Cheung expressed that she quit cared on how people think about her. She believed that if she studies well, parents and friends will like her and proud of her so that she concerns on her study. She expressed that she is shy to communicate with stranger but she quite concerned on having a wide social life. Stress and coping Miss Cheung expressed that her major concern and pressure was her studying. She worried that she stayed at the hospital in which she cannot attend to school and afraid of keeping up the progress. When she feels stress, she prefers eating and listening music to release pressure. Values and beliefs Miss Cheung does not have religious. She believed that she can handle things on her own. She expressed that her family and friends were important for her who always gave her supports. All possible nursing diagnosis with priority: Ineffective airway clearance is related to viscous secretions secondary to pneumonia as evidence by inability to remove airway secretion. Impaired gas exchange is related to excessive secretion secondary to infection as evidence by verbally complained of shortness of breath. Imbalanced nutrition: less than body requirements is related to increased caloric requirements and difficulty in ingesting sufficient calories secondary to infection as evidence by verbally reported weight loss and decreased diet intake. Deficient fluid volume is related to vomiting and decreased motivation to drink liquids as evidence by dry lip and tongue and insufficient oral fluid intake. Activity intolerance is related to inadequate motivation secondary to generalized weakness as evidence by verbally reported of weakness and lost of power. Reasons for priority: After the assessment, the nursing diagnosis made for Miss Cheung were ineffective airway clearance, impaired gas change, imbalanced nutrition: less than body requirement, deficient fluid volume and activity intolerance. The first priority is ineffective airway clearance as the accumulation of thick secretions affects the effective ventilation and may cause cyanosis and dyspnea. It is important for her to be effective airway clearance to reduce the risk of dyspnea. The second priority is deficient fluid volume which may cause dehydration and electrolyte imbalance. These may affect organ function like heart failure in serious. It is important for her to replace fluid volume and prevent harmful effect. The third priority is imbalanced nutrition: less than body requirement. As Miss Cheung had decreased diet intake from the sickness and nutritional requirements would be increased to enhance the immune system, lack of nutrition should be considered. After that, diet modification of balanced diet should be educated to Miss Cheung due to BMI higher than normal range. The fourth priority is impaired gas change which affects the oxygen delivery to the cells. Once the ineffective airway clearance is managed, the problem can be resolved. The last priority is activity intolerance because it is caused by ineffective airway clearance, impaired gas change and discomfort. Once these problems are managed, her activity level has been returned normal. Focus assessment for the altered functional health patterns: Activity and exercise (Data collection on 2/12/2013 at 11am) Subjective Data: Miss Cheung reported that she got cough and fever from 27th November, 2013 in which cough had become worst with increased sputum production. However, she cannot cough out sputum effectively. Once she can cough out, the sputum was yellowish and sticky with small amount. She felt fatigue and malaise especially having exercises. She reported that she felt shortness of breath and increased sputum production when she walked for a while. She got PE lesson on the 29th November, 2013, then, she coughed worst and got breathing difficult. After taking a rest, breathing difficult had been relieved but still cough with increased sputum production and difficult to cough out. She reported that she needed more efforts to take a breath after walking up stairs or doing exercise in these few days. She also expressed that she usually went shopping with friends after school, but she lost of interested after getting sick as she felt tired and wanted to have a rest all the time. She was asked to walk around the ward for about five minutes. She reported that she needed to go to bed as she felt tired and mild breathing difficulty in which she needed more effort to breath and she cannot tolerate more. Objective Date: She can breathe spontaneously through nasal. The serum C-reactive protein (28.2 mg/L) and white blood cell (11.9X109/L) were higher than normal indicated infection and inflammation condition. Chest X-ray indicated that left lower zone had mild haziness. She was diagnosed as left sided pneumonia. Her respiratory rate was 22 breaths per minute on the admission day which was tachypnea. Her respiratory rate on 2nd December, 2013 at 10am was 21 breaths per minute indicated tachypnea with regular rrhythm. Her chest wall moved in symmetrical and did not use of accessory muscle. She was asked to walk around the ward for about five minutes. When she changed position from lying to stand, she had coughed more but she cannot cough out sputum effectively. Her SpO2 was kept monitoring during walking which was 96 to 98%. She had not appeared cyanosis but had rapid and shallow breathing during walking. Before walking, her pulse rate was 105 beats per minute; blood pressure was 114/66 mmHg; respiratory rate was 21 breaths per minute and SpO2 was 98%. After having a walk, her pulse rate was 120 beats per minute; blood pressure was 110/67 mmHg; respiratory rate was 24 breaths per minute and SpO2 was 95%. After auscultation of her lung sound, crackling and bubbling sounds had been noted. Nutrition and metabolism (Data collection on 2/12/2013 at 1130 am) Subjective Data: Miss Cheung expressed that she had lost of appetite and decreased diet and fluid intake from 27th November, 2013 because of getting sick and nausea. She expressed that she got fever, headache, sore throat and cough which were the major reasons of discomfort. She expressed that she had not contacted to people who were getting sick and had not got any vaccination. She expressed that she felt she lost weight since she got sick. She had taken 1/3 diet on every meal time and total 600ml fluid on 1st December, 2013. She got totally four times urination on 1st December, 2013. She got once urination from 2nd December, 2013 in the morning and reported that it was yellowish with small amount and odor. She reported that she got nausea especially after excessive coughing. She got once vomiting on 1st December, 2013 and once vomiting on 2nd December, 2013 morning with yellowish fluid and undigested food. Objective Data: Miss Cheung’s body weight was 75.1 kilogram and height was 164.5 centimeter in which her BMI was 27.8 which was overweight. Physical assessment had been done on the 2nd December, 2013 morning. Her body temperature was 38.3 oC which was hyperthermia; blood pressure was 115/78 mmHg’ SpO2 was 97% in room air and her pulse rate was 105 beats per minutes which were normal. Her respiratory rate was 21 breaths per minute which was tachypnea. Her skin turgor and capillary refill time were within 3 seconds indicated normal but with dry mucous membrane. She had dry lip and tongue. Her Glasgow Coma Scale was 15/15 which was fully consciousness. References: Anthony, R.W., Brain, W., Clive, K., Gary, W., James, P., Rienk, P. (2004). Augmentin (amoxicillin/ clavulanate) in the treatment of community – acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. Journal of Antimicrobial Chemotherapy, 53, i3 – i20. doi: 10.1093/jac/dkh050. Barry, M.P., Irwin, H.R., Kristen, E.D. (2011). Water, Hydration and Health. Nutr Rev, 68(8), 439 – 458. doi: 10.1111/j.753-4887.2010.00304.x Carpenito-Moyet, L.J. (14th ed.). (2013). Nursing diagnosis: Application to clinicalpractice. Mickleton, N.J.: Lippincott Williams Wilkins. David, R.T., Eric, G.T., John, E., Larry, L., Laurence, Z.R., Steven, A.L., Todd, R.C., Richard, G.S. (2008). Understanding Clinical Dehydration and Its Treatment. Jamda, 9, 292 – 301. Del, M.C, Guppy, M.P.P, Mickan, S.M, Thorning, S. (2010). Advising patients toincrease fluid intake for treating acute respiratory infections (Review). The Cochrane Collaboration, 2, 1 – 10. Genc, A., Guneri, E.A. (2008). Effect of deep breathing exercises on oxygenationafter major head and neck surgery. Otolaryngology – Head and Neck Surgery, 139, 281 – 285. Griffint, J., Maughan, R.J. (2003). Caffeine ingestion and fluid balance: a review. JHum Nutr Dielet, 16, 411 – 420. Kim, C.E, William, N.R., Wong, K.M.T. (2011). Sputum-Based MolecularBiomarkers for the Early Detection of Lung Cancer: Limitation and Promise. Cancer, 3, 2975 – 2989. doi: 10.3390/cancers3032975 Singh, R. (2003). Fluid Balance and Exercise Performance. Mal J Nutr, 9(1), 53 – 74. Tina, M. (2007). Respiratory assessment in adults. Nursing Standard, 21(49), 58 – 60.

FutureCola

The reports answers five questions elated to the case of cola in China. These questions include; 1 How effective is the positioning of Future Cola? ; 2 What are the factors that have contributed to Future Cola's growth so far? ; 3 How might Coca Cola and Pepsi Co. Respond to Wahoo in the carbonated drinks category? ; 4 What should Wahoo do to anticipate and respond to the next level of competition? ; 5 what other strategies and tactics could Future Cola employ to continue to grow its market share?The author has used different tools to answer these questions including SOOT, PEST, Five Forces Model, Anions Matrix, Core Competencies and Competitive Advantages. To measure the effectiveness of Strategic Positioning of Future Cola the author first analyzed its strategic positions using competitive advantage theory followed by SOOT and PEST analysis as well as porter's five forces model which helped to explore the strengths, weaknesses, opportunities and threats for the business.Also the po litical, social, economic and technological factors that are contributing to the success of Future cola have been discussed. Also the business environment was analyzed by identifying threats of substitute products, threat of new products, intense rivalries among existing players, bargaining power of appliers and bargaining power of buyers. It was found that Future Cola has become a successful brand and is competing with international brands in China because it has been advertised as a patriotic brand Intelligent.Further Wahoo Group holds vast wholesale and retail network. Also the prices of Future Cola are low as compared to other brand. Pepsi and Coca Cola can meet the rising demand and success of future bola by adopting a localized marketing strategy, lowering prices and introducing new flavors that are close to the taste that Chinese people like. 4 Report also offers recommendation to Future Cola for becoming leader in China and or succeeding globally. These recommendations inclu de; target developing nations, medium calorie drinks as well as drinks with natural ingredients Q-1.How effective is the positioning of Future Cola? Strategic Positioning â€Å"Pretax profit last year at Hangout Wahoo, the Chinese beverage giant controlled by the country richest man Gong Singing, climbed by 18% to 10. 1 billion Yuan, or $1. 6 billion, amid a fall in raw material costs, a company spokesman told Forbes†. (Forbes, 2013) The Company started its operations in 1987 as a milk factory that was run by a School with the goal of providing children with nutrient drinks. The company is among top five global beverage producers.Future Cola was introduced by Wahoo Group of China in 1998 at the time when carbonated drinks had become popular and this category was covering half of the volume of the soft drink industry. In 1997 the output of cola in China was 1. 36 million with 80% combined market share of Pepsi and Coca Cola. Currently on number three in China and Number five i n the world among soft drink manufacturers Wahoo has successfully achieved and maintained its position. (Nancy Dad, 2004) Competitive Advantage The competitive advantage of Future Cola lays in its generic business strategy that fermentation strategy.The Future Cola gained success because the CEO was prepared on how multinationals will respond to this new brand and prepared to compete with response as well increase its market share in the future. (Nancy Dad, 2004) The outward evidence of competitive advantage for Future Cola can be seen in its success in China as third major soft drink in China and high growth in sales. Future Cola is enjoying superior delivered cost position due to low costs 6 international brands and close to the Chinese taste and culture. Positional advantage has many benefits and cannot be exploitedIn theory, the competitive advantage is described from two perspectives; 1 . Resource 2. Capabilities As regards resources Future cola has competitive advantage that b ecause it has vast distribution network, financial capacity, its manufacturing and distribution network in low cost, has production capacity, it purchases raw material. Capabilities include focused knowledge, orientation of customer service, expertise in design, experience as a food and beverage company, holds trade relationship in China, is able to utilize relevant technologies, capability to design system as well as to response capability.SOOT Analysts Strengths Weaknesses ;Brand name resembling to Coca Cola ;Fifth biggest brand in the world ;Third Major Brand in China ;China' National Brand ;Vast network of wholesale ;Cheaper than its competitors ;Attractive Marketing Strategies ;Brand Management Skills ;Not an international brand like Pepsi and Coca Cola ;Focusing less on Threats Opportunities ;Great Competition ;Changing consumption trends ;Restriction on carbonated drinks ;Can expand its network to emerging markets and developing nations to ;Can introduce different flavors to grow sales ;Can acquire major players in ChinaFigure I-SOOT Analysis Future Cola Brand name resembling to Coca Cola which is already familiar One among the five biggest brands in the world Third Major Brand in China Established as China' National Brand Vast network of wholesale Cheaper than its competitors Attractive Marketing Strategies and Brand Management Skills Weaknesses 8 Not an international brand like Pepsi and Coca Cola Can expand its network to emerging markets and developing nations to increase sales and profits Can introduce different flavors to grow sales Can acquire major players in China Great Competition with presence of major brands Changing consumption trends

Pros and Cons in Fox Hunting

In this paper I will discuss the issues surrounding foxhunting. I will mention the pros and the cons and then I will decide if fox hunting should be criminalized. I will begin with the pros. Just a little intro on foxhunting and what it is. In Britain mostly England foxhunting is a popular sport. Hunters set out on horse back following hounds witch are following the scent of foxes. When the hounds find the fox they rip it apart and the hunters watch this happen and then go off to find more foxes. The foxhunters generally wear coats of bright scarlet, called pinks. The members of the club support the hunt, and the Master of Fox Hounds (MFH) usually maintains it. Some of the pro points of fox hunting are, the fox is a pest and its population needs to be controlled. Farmers are concerned and agree with this. Responsible fox management includes maintaining a healthy population at a level, which it can grow without threatening livestock or other wildlife. Fox hunting is the most natural method of management: by its nature it takes out the old sick and injured foxes. Fox hunting does not just help control fox numbers, landowners with an interest in fox hunting plant and maintain coverts, woodlands and copses for the benefit of all wildlife. If it wasn't for fox hunting they would over populate and they would eventually have to be caught and be shot or gassed. Foxes cause significant lamb, piglets, and poultry losses. Scientific estimates vary from 0. 5% to 5. %; even at 2% the cost to a typical farmer with 1500 lambs and piglets is worth over $2200. Without control the percentage would increase considerably. If there was a ban on fox hunting 15,000 people whose jobs directly depended on fox hunting would be out of work, some 14,000 foxhounds would have no future, as these working pack hounds would not make suitable pets. The species is not endangered Now on to the cons of the subject, the official foxhunting season begins on November 1st and continues through April. Some hunts even go into May. Fox cubs are usually born in March, which means that a pregnant and nursing vixen (female fox) are hunted and killed by hounds. Incidents of vixens being killed and unborn cubs being scattered around by the hounds at a kill, these have been recorded on film. There are also several recorded instances of hounds attacking small pet dogs and cats which, although fatally savaged survived the initial attack, further evidence that the hounds do not kill their prey instantly. Generally people see it as a cruel blood sport that should be banned. Many have argued that if fox hunting is banned jobs will be lost, however this is unlikely to happen because labor and other resources associated with fox hunting would be reinvested in other enterprises and activities. Drag and bloodhound hunts represent a cruelty-free alternative to mounted fox hunting. Drag hunting involves riding horses across open country in pursuit of a scent left by a human, either running on foot or trailed on scented â€Å"drag† from a horse. Bloodhound hunts differ from drag hunts in that there are fewer hounds and the hounds chase a human quarry (e. . a local athlete), rather than dragged artificial scent. Because of this few, if any jobs would be lost if the people that were involved in fox hunting chose to participate in either of these activities. A ban would also increase the availability of resources previously used by hunting to other rural business. For example, horse stables could be converted to living accommodation or office space. Overall, it would appear that a ban on fox hunting is unlikely to have any significant negative effect on rural employment. Existing evidence suggests that many jobs will be saved or created by a switch to drag or bloodhound hunting, and by the growth of new activities. Now for my conclusion if fox hunting should be criminalized, both sides have good arguments but I am against foxhunting because there are other methods of getting rid of the fox. From the research I have done I noticed that the hunters don†t just go after the fox because there is too much of them, but they also get a rush out of it. That†s why there are drag hunting and bloodhound hunts. A survey was done by 1000 farmers and they found that support for fox and drag/bloodhound hunting was fairly similar. 56% of farmers would not allow drag/bloodhound hunting on their land, compared to 48% opposed to foxhunting. Based on these findings, the league against cruel sports extrapolated that as many as 60 000 farmers in the UK, covering up to 7. 5 million hectares of land, would allow drag hunts on their land. Jobs would not be lost because the people and the hounds can transfer to drag hunting. I believe that a ban on foxhunting would be beneficial toward the economy and a new era would begin.

The Argument For The Constitution Of The United States Essay

The Argument for the Constitution of the United States of America On July 3rd, 1776, the Second Continental Congress unanimously declared the independence of the thirteen United States of America from Great Britain. Determined to unify the thirteen colonies, the Continental Congress adopted the Articles of Confederation and Perpetual Union, the first constitution of the United States, on November 15, 1777. However, ratification of the Articles of Confederation by all thirteen states did not occur until March 1, 1781. Although the articles did not prevent the United States from winning independence, the innate flaws of the articles became apparent in the years following the revolution. The problems of the weak, purely legislative national government became too prevalent for agents of the revolution, such as James Madison and George Washington. Madison and Washington were strong supporters of a federal, or national, constitution, and on June 21, 1788, congress ratified the Constitution of the United States. And in doing so, violated the â€Å"Revolutionary Ideology† and the will of the American people. The Revolutionary War effectively ended on October 17th, 1781. Having successfully won independence, that task shifted to maintaining independence. The newly independent ‘United’ States, faced an array of issues, and proved to be anything but united under the existing Articles of Confederation. In hindsight, analyzing the arguments against the articles, as well as theShow MoreRelatedThe Debate Over Ratification Of The United States Constitution940 Words   |  4 PagesAmerican history has been the arguments made by the Federalists and the Antifederalists over the ideas and powers stated within the United States Constitution. 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