Brand management Essay Example | Topics and Well Written Essays - 2750 words

Brand management - Essay Example Specifically that brand aims at reaching out for the professional class, which can afford to purchase and maintain this brand of vehicle (Spiggle, Nguyen, & Caravella, 2012). The company has diversified its models to fit the various demands of their target customers by manufacturing small and bid body size cars, all body types. Apart from being a part top-class vehicle, Mercedes model is preferred for its safety features. Mercedes-Benz has invested a lot on the safety of their vehicles by considering its high quality brakes, stable body structure and installation with airbags for sensitive impacts. This makes it ideal for its target class, who consider safety as a priority while selecting a vehicle brand. The originality of the vehicle makes its one of the most unique automobile brands in the automobile industry. For instance, its body type is unique and different from that of competitor companies. As depicted in the company’s website, the model takes the body of a â€Å"chicken† that is complex to define and hence unique only to the company. Uniqueness is a feature that the upper-class associated with style and fashion of an automobile (Whitson, R 2013). This is the major reason why this brand has received a lot of favoritism from the professional class. Over 80% of the purchases of the Merc edes-Benz brand prefer it for its optimal fashion design. Quality is an important aspect of the Mercedes-Benz brand that makes its preferable by its target customers. Although its repair and maintenance are expensive, it does not demand for frequent repair and maintenance, hence giving a desirable service to its users. The physical appearance makes it a likeable brand. Mercedes-Benz has a shiny appearance that reflects its classy design and style which makes it admirable from a far. Technology is another important aspect of the brand that makes it a favorite for the youths in the middle. For instance the

Operations Management Essay Example for Free

Operations Management Essay 1. History Since starting out in 1989, the Glad Group has grown to become one of Australias leading property service providers. Initially established as Glad Cleaning Services, the company provided cleaning solutions for shopping centres and businesses. In November 2006 Glad Cleaning Services re-branded itself to the Glad Group, now offering integrated property solutions. With a strong focus on customer service and great value pricing, the Glad Group has continued to develop and maintain long-term relationships with its clients over the years. Company founders Nick and Lucy Iloski recognised there was a need to offer an integrated service that specialised in flexible solutions for the retail and commercial markets. Their customer focused approach was welcomed in the market and the company grew rapidly. Today, the Glad Group excels in five key property services: Retail Cleaning, Commercial Cleaning, Security, Maintenance, and Waste Management Environmental Solutions. Glad offers these services individually, or as an integrated property solution. 2. Introduction 2.1. Customer Service The Glad Group is based on a culture of integrity and dedication. Commitment without compromise underpins every operation Glad undertakes. Glad Group takes customer service seriously and aims to deliver enduring value through innovative, customer focused property solutions that provide a safe, clean and friendly environment for clients, their customers and the community. High standards of customer service are obtained through employee training, compliance, and industry innovation and embracing technology. Individuals are empowered through an environment of support and encouragement, making service and solutions quicker and easier for clients. The Glad Group believes trust, integrity, and dependability is essential in every working relationship and always treats clients, employees, contractors and community ethically and with respect. 2.2. Quality Control The Glad Group is accredited to ISO 9001 Quality Management System, AS 4801 Occupational Health and Safety and ISO14001 Environmental Management System. Glad’s comprehensive integrated management system along with the use of Praxeo and Kevah software ensures the staff comply with the current laws, acts, regulations and codes of practice. This has created a safer and more secure work environment, resulting in a progressive reduction in incidents and accidents. 3. Location The Glad Group has been providing property services to the Australian market since 1989. Today the Glad Group is proud to provide services nationally to a range of market sectors including major, regional and neighbourhood shopping centres, commercial buildings, schools and universities, federal, state and local government offices and financial institutions. Glad Commercial Cleaning has several work locations. Investa Property Group, which is one of the clients of Glad Group, owns the office building at Deutsche Bank Place, 126 Phillip Street, Sydney. Located on the prime eastern edge of the CBD, Deutsche Bank Place has commanding and unrestricted views of Sydney Harbour and the Botanical Gardens and it is very convenient for employees to travel to and from. Deutsche Bank Place is a 240 m skyscraper in Sydney, New South Wales, Australia. It is located at 126 Phillip Street in the north-eastern end of the central business district, across the road from Chifley Tower. Construction began in 2002 and was completed in 2005. The buildings architect is Norman Foster of Foster and Partners. Deutsche Bank is the primary tenant, occupying 9 floors and owning the naming rights. It is owned and managed by Investa Property Group. Other major tenants are Allens Arthur, Bain Company and Seven Wentworth. The 42,256m ² of total net lettable area boasts a NABERS Energy rating of 4.5 stars and a spectacular entry plaza. The building also offers cafà ©s, a brassiere, tenant showers, lockers and bike racks, a child care centre and outdoor areas. Located at the top of Hunter Street in the heart of the CBD, it is readily accessible by car and all public transport options. 3.1. Access It is very important these kind of commercial buildings to be easily accessible because there are lots of employees working in this building assuming 100 people for each level for a building that has 31 commercial levels beside other workers such as cleaners and securities as well as to receive the deliveries inside conveniently and timely. 4. Action Plans 4.1. Sustainability At Glad people believe corporate responsibilities include protecting the environment. Thats why an accredited environmental management system was developed. This system helps identify products or services that could affect the environment. To assist the system several policies, codes of practice, guidelines and International standards were adopted which exceed legislative compliance. All this ensures the best outcome for the environment. Every Glad employee receives training and development in the companys environmental system. It is very important to continuously develop and tailor site specific training and education packages that focus on recycling and sustainability solutions and procedures. The Glad Group use and offer the following environmentally friendly products and services: ï  ¶Green cleaning products and water wise machines Reusable microfiber cleaning cloths Water recycling products Biodegradable products Waste management (recycling) consultancy Recently, Glad acquired the most powerful portable high pressure steam cleaner in Australia. This new chemical free steam cleaner is a powerful unit that is not only environmentally friendly but also provides: Improved levels of sanitisation Indoor/outdoor applications Graffiti removal Water heated to extremely high temperatures killing bacteria, mould and viruses in large areas Chemical free portable high pressure steam cleaning for carpets Ideal for pavement/hard surfaces/entries facades Pollution free operation Uses recycled water system Extraction of waste water (waste water is taken to the site and then removed from the site) 4.1.1. New Steam Clean Technology The Glad Group have mobile chemical free cleaning technology that can come to your site and clean just about anything, from floors and carpets, to car parks and railway platforms. Not only does the system of high pressure (3000 PSI) and steam (260 °C) clean, it also removes the waste and residue instantly via the extraction system (400 ft of hose). Furthermore, not only does the truck bring its own water, it takes the waste water away for recycling. 4.2. Risk and Insurance Management The Glad Group takes hazard assessment and risk management very seriously. Glad’s comprehensive approach ensures clients; their customers and employees are safe from hazards that might cause injury. Glad commission Proclaim to actively investigate and manage public liability claims swiftly and professionally on behalf of the Glad Group and clients. Prior to the commencement of any contract a risk analysis is conducted, site specific safe work method instructions are designed and then audit on an ongoing basis. To further improve safety, Glad also operates a cutting edge software system called Glad Easi. Its a touch screen reporting program designed to provide an effective and auditable trail of information regarding employees, contractors and visitors within work sites. Due to the comprehensive approach to health safety and the efficiency of reporting methods, the Glad Group has one of the lowest public liability and workers compensation premiums in the industry. This results in considerable cost savings to clients. 4.3. HR Compliance The Glad Group is accredited to ISO 9001 Quality Management System, AS 4801 Occupational Health and Safety and ISO14001 Environmental Management System. Glad’s comprehensive integrated management system along with the use of Praxeo and Kevah software ensures the staff comply with the current laws, acts, regulations and codes of practice. This has created a safer and more secure work environment, resulting in a progressive reduction in incidents and accidents 4.4. Induction and Training All Glad Group employees are selected through an extensive interview process. Applicants must also provide evidence of their eligibility to work in Australia. Further checks such as, criminality record and immigration (DIMA) are then conducted by the Human Resource Department to ensure eligibility. Prior to issuing all cleaners, security guards and maintenance personnel with photo identification cards, the Glad Group provide detailed induction training at Head Office via Glad Compliance Department. This includes a number of training videos incorporating OHS endorsed procedures and detailed site instructions. All training is evaluated and recorded on an employees electronic training record. Eligible staff is also enrolled in Certificate I, II, III and IV courses in Cleaning and Asset Maintenance. Each of supervisors has a certificate in Asset Maintenance and extensive site experience for commercial and retail sites. 5. Innovation 5.1. G.M.R The Glad Mobile Reporting system is a powerful and flexible software solution used on hand held PDAs. This software has assisted the Glad Group in the management of property services and the assets and life cycles of our clients properties. The benefit it provides to clients is real-time on-site inspection reports such as: Quality assurance inspections Incident/accident reporting Damage/condition reporting OH S audits 5.2. Glad Easi The GLAD EASI system is a touch screen software solution designed to provide an audit trail of vital information for the Glad Group and its clients. The GLAD EASI system captures data such as: Time and attendance Employees entering and exiting the premises with delivery of information at both entry and egress Authorised entry for contractors and safety requirements to be met on entry and egress Safety aspects associated with the sites The system is also used for ongoing training of site personnel via extensive OHS video series. 5.3. Escalator Machine An innovative widely used easy to move machine to clean hard floor, stairway and escalator is coming soon to be used not only for ease of use but to save time as well.

Musculoskeletal Case Study: Rheumatoid Arthritis

Musculoskeletal Case Study: Rheumatoid Arthritis Rheumatoid Arthritis with Hip Arthroplasty   Ã‚   S.P. is admitted to the orthopedic ward. She has fallen at home and has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: *She is a *75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5 feet 3 inches; weight is 118 pounds. She has a *50-pack-year smoking history and denies alcohol use. She has severe rheumatoid arthritis (RA), with evidence of cartilage and bone destruction, along with joint deformities. She had an upper gastrointestinal bleed in 1993, and had coronary artery disease with a coronary artery bypass graft 9 months ago. Since that time she has engaged in* very mild exercises at home. Vital signs (VS) are 128/60, 98, 14, 99 ° F (37.2 ° C), SaO2 94% on 2 L oxygen by nasal cannula. Her oral medications are *rabeprazole (Aciphex) 20 mg/day, *prednisone (Deltasone) 5 mg/day, and *methotrexate (Amethopterin) 2. 5 mg/wk. **What anatomical stage of Rheumatoid Arthritis does SP have? (1) Stage I-Early No destructive changes on radiograph, possible radiographic evidence of osteoporosis Stage II-Moderate Radiographic evidence of osteoporosis, with or without slight bone or cartilage destruction, no joint deformities (although possibly limited joint mobility), adjacent muscle atrophy, possible presence of extra-articular soft-tissue lesions (e.g., nodules, tenosynovitis) Stage III-Severe Radiographic evidence of cartilage and bone destruction in addition to osteoporosis; joint deformity, such as subluxation, ulnar deviation, or hyperextension, without fibrous or bony ankylosis; extensive muscle atrophy; possible presence of extra-articular soft-tissue lesions (e.g., nodules, tenosynovitis) Stage IV-Terminal Fibrous or bony ankylosis, stage III criteria List at least four risk factors for hip fractures. (4 pts) Age. The risk for hip fractures increases as we age. In 2010, more than 80% of the people hospitalized for hip fractures were age 65 and older, according to the National Hospital Discharge Survey (NHDS). Sex. About 70 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss. However, men also can develop dangerously low levels of bone density. Cortisone medications, such as prednisone, can weaken bone if taken for long term. Rabeprazole (Aciphex) and methotrexate (Amethopterin) could cause dizziness and more prone to falling. Physical inactivity (very mild exercises at home). Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. Not participating in regularly weight-bearing exercise, may lead to lower bone density and weaker bones. Tobacco use. Can interfere with the normal processes of bone building and maintenance, resulting in bone loss. 2.Place a star or asterisk next to each of the responses in question 1 that represent S.P.s risk factors. (1) Case Study Progress       S.P. is taken to surgery for a total hip replacement. Because of the intracapsular location of the fracture, the surgeon chooses to perform an arthroplasty rather than internal fixation. The postoperative orders include: Chart View Why is the patient receiving enoxaparin (Lovenox) and warfarin (Coumadin)? (4 pts) In your answer, also explain how these 2 medications are used together and the rationale behind how they are used. Deep venous thrombosis (DVT) may form in leg veins as a result of inactivity, body position, and pressure, all of which lead to venous stasis and decreased perfusion. DVT, especially common in older adults and obese or immobilized individuals, is a potentially life-threatening complication because it may lead to pulmonary embolism. The most commonly used anticoagulants are unfractionated heparin (UH), low-molecular weight heparins (LMWHs), hirudin derivatives, and coumarin compounds. Unfractionated heparin (heparin sodium, commonly known as heparin) acts directly on the intrinsic and the common pathways of blood coagulation. Heparin inhibits thrombin-mediated conversion of fibrinogen to fibrin. It also potentiates the actions of antithrombin III, inhibits the activation of factor IX, and neutralizes activated factor X by activating factor X inhibitor. LMWH is effective for the prevention and treatment of DVT. LMWHs are derived from heparin, but the molecule size is approximately one third that of heparin. Enoxaparin (Lovenox), dalteparin (Fragmin), and ardeparin (Normiflo) are examples of LMWHs. LMWH has a greater bioavailability, more predictable dose response, and longer half-life than heparin with less risk of bleeding complications. LMWH has the practical advantage that it does not require anticoagulant monitoring and dose adjustment ( Hirsh , Bauer , Donati , Gould , Samama , Weitz , 2008). LMWH is administered subcutaneously in fixed doses, once or twice daily. Coumarin compounds, of which warfarin (Coumadin) is the most commonly used, exert their action indirectly on the coagulation pathway. Warfarin inhibits the hepatic synthesis of the vitamin K- dependent coagulation factors II, VII, IX, and X by competitively interfering with vitamin K. Vitamin K is normally required for the synthesis of these factors. Oral anticoagulants are often administered concurrently with heparin. Warfarin requires 48 to 72 hours to influence prothrombin time (PT) and may take several days before maximum effect is achieved. Therefore a 3- to 5-day overlap of heparin and warfarin is required. The clotting status should be monitored by activated partial thromboplastin time (aPTT) for heparin therapy and the international normalized ratio (INR) for coumadin derivatives. The INR is a standardized system of reporting PT based on a referenced calibration model and calculated by comparing the clients PT with a control value. Other tests to monitor anticoagulation may b e used. For DVT prophylaxis, low-dose unfractionated heparin, LMWH, or warfarin (Coumadin) can be prescribed depending on the clients level of risk and weight. Unfractionated heparin is typically taken by subcutaneous (subQ) route and prescribed at 5000 units q12h subQ for clients at low and moderate risk or 3500 to 5000 units q8h subQ for clients at high risk. LMWH is usually scheduled at 30 mg q12h subQ or 40 mg daily subQ. LMWH is rapidly replacing heparin as the anticoagulant of choice to prevent DVT in clients at high risk. In fact, LMWH is considered the most effective form of prophylaxis in hip surgery, in knee surgery, and following major trauma. Low-dose warfarin is usually reserved for clients with the highest DVT risk. It is quite common for a person to be taking both Coumadin and Lovenox at the same time. Lovenox begins working right away, while Coumadin does not. In fact, in the period of time when a person first begins taking Coumadin, the drug may actually increase the risk of clots for a short period of time. Therefore, Coumadin and Lovenox are often taken together. The Lovenox prevents clots while the Coumadin begins working. The Lovenox can be stopped once the INR is in the appropriate range. 4.S.P. received blood as an intraoperative blood salvage. Which statements about this procedure are true? (Select all that apply.) a.The blood that is lost from surgery is immediately re-administered to the patient (Salvaged blood should be washed. Salvaged blood that is not washed or otherwise processed (eg, centrifuged) has low hemoglobin levels (7 to 9 g/dL), residual anticoagulant, dysfunctional platelets, thrombogenic substances, free hemoglobin levels, and fat emboli that might lead to coagulation abnormalities). b.(True) The blood lost from surgery is collected into a cell saver    (Centrifuge-based RBC salvage with the intraoperative cell salvage machine (commonly referred to as a cell saver) starts with the surgeon aspirating blood from the surgical field through a suction wand. The blood is mixed with an anticoagulant as it is aspirated (eg, heparin or citrate) to prevent coagulation [16]. Typically, heparin in saline with a concentration of about 30,000 units/L is used. This solution is slowly and automatically added to the aspirated blood at a rate of 15 mL per 100 mL of collected blood [16]. During subsequent washing of the collected blood, all but a trace of heparin is removed). c.One hundred percent of the red blood cells are saved for reinfusion (other components in the blood such as platelets and contaminants can also adhere to these filters, but at least 85 percent of RBCs pass through the filter and into the patient). d. This procedure has the same risks as blood transfusions from donors. e.(True) The salvaged blood must be reinfused within 6 hours of collection. (Blood collected by intraoperative blood salvage may be stored either at room temperature for up to six hours or at 1 to 6 °C for up to 24 hours, provided that blood is collected under aseptic conditions with a device that provides washing and that cold storage is begun within six hours of initiating the collection. Such stored blood must be properly labeled). List four critical potential postoperative problems for S.P. (4 pts) Infection. Fever above 38 °C (100.4 °F) is common in the first few days after major surgery. Most early postoperative fever is caused by the inflammatory stimulus of surgery and resolves spontaneously. However, postoperative fever can be a manifestation of a serious complication. A thorough differential diagnosis of postoperative fever includes infectious and noninfectious conditions that occur following surgery. Fever may arise due to a surgical site infection (SSI), or from other hospital-related conditions, including nosocomial pneumonia, urinary tract infection, drug fever, and deep vein thrombosis. In evaluating a postoperative patient with fever, it is important to consider a broad differential, and not to assume that fever is due to infection. Fever as a manifestation of infection may be reduced or absent in immunocompromised patients including those receiving glucocorticoids, cancer chemotherapy, post-transplant immunosuppression, and also in some patients who are elderly or have chronic renal failure. Hypoxemia, specifically a PaO2 of less than 60 mm Hg, is characterized by a variety of nonspecific clinical signs and symptoms, ranging from agitation to somnolence, hypertension to hypotension, and tachycardia to bradycardia. Pulse oximetry will indicate a low oxygen saturation (below the 90 to 92% range). Arterial blood gas analysis may be used to confirm hypoxemia if the pulse oximetry indicates a low O2 saturation. Low oxygen saturation may be corrected by encouraging deep breathing and coughing or by increasing the amount of oxygen delivered. The most common cause of postoperative hypoxemia is atelectasis. Atelectasis (alveolar collapse) may be the result of bronchial obstruction caused by retained secretions or decreased respiratory excursion. Hypotension and low cardiac output states can also contribute to the development of atelectasis. Other causes of hypoxemia that may occur in the PACU include pulmonary edema, aspiration, and bronchospasm. Hypotension is evidenced by signs of hypoperfusion to the vital organs, especially the brain, the heart, and the kidneys. Clinical signs of disorientation, loss of consciousness, chest pain, oliguria, and anuria reflect hypoxemia and the loss of physiological compensation. Intervention must be timely to prevent the devastating complications of cardiac ischemia or infarction, cerebral ischemia, renal ischemia, and bowel infarction. The most common cause of hypotension in the PACU is unreplaced fluid and blood loss; thus, treatment is directed toward restoring circulating volume. If there is no response to fluid administration, cardiac dysfunction should be presumed to be the cause of hypotension. Deep venous thrombosis (DVT) may form in leg veins as a result of inactivity, body position, and pressure, all of which lead to venous stasis and decreased perfusion. DVT, especially common in older adults and obese or immobilized individuals, is a potentially life-threatening complication because it may lead to pulmonary embolism. Clients with a history of DVT have a greater risk for pulmonary embolism. Pulmonary embolism should be suspected in any client complaining of tachypnea, dyspnea, and tachycardia, particularly when the client is already receiving oxygen therapy. Manifestations may include chest pain, hypotension, hemoptysis, dysrhythmias, or heart failure. Definitive diagnosis requires pulmonary angiography. Superficial thrombophlebitis is an uncomfortable but less ominous complication that may develop in a leg vein as a result of venous stasis or in the arm veins as a result of irritation from IV catheters or solutions. If a piece of a clot becomes dislodged and travels to the lung, it can cause a pulmonary infarction of a size proportionate to the vessel in which it lodges. How will you monitor for excessive postoperative blood loss? (5 pts) Observe the dressing and incision for signs of bleeding Restlessness Confusion Anxiety Feeling of impending doom Decreased level of consciousness Weakness Rapid, weak, thread pulses Dysrhythmias Hypotension Narrowed pulse pressure Cool, clammy skin Tachypnea, dyspnea, or shallow, irregular respirations Decreased O2 saturation Extreme thirst Nausea and vomiting Pallor Cyanosis Obvious hemorrhage The rate and volume of bleeding, vital signs, and laboratory results should be closely monitored to assess the best approach to and aggressiveness of intervention. It is important to not allow the patient to become moribund before initiating life-saving measures. Post op Day 1, S.P. states that she is having 8/10 pain. List 3 thingsthat you would assess in order to determine why she is having the pain and then state 2 nursing interventions. (5 pts) Complications associated with femoral neck fracture include nonunion, AVN, dislocation, and degenerative arthritis. Postoperative pain is usually most severe within the first 48 hours and subsides thereafter. Variation is considerable, according to the procedure performed and the clients individual pain tolerance or perception. The client should be observed for indications of pain (e.g., restlessness) and questioned about the degree and characteristics of the pain. Identifying the location of the pain is important. Incisional pain is to be expected, but other causes of pain, such as a full bladder, may also be present. Pain assessments can be measured with a variety of scales such as asking a client to rate his or her pain on a scale of 0 to 10. Perform a comprehensive pain assessment to include the following: characteristic, onset and duration, quality, intensity and severity. In the early postoperative period, there is a potential for neurovascular impairment. The nurse assesses the clients extremity for (1) colour, (2) temperature, (3) capillary refill, (4) distal pulses, (5) edema, (6) sensati on, (7) motor function, and (8) pain. Provide client optimal pain relief with prescribed analgesic as ordered to relieve acute pain and to prevent pain from becoming too severe. Teach and assess clients correct use of patient-controlled analgesia to ensure effectiveness. Use nonpharmacological interventions to relieve pain, such as distraction, massage, relaxation, and imagery, for client use in lieu of or in conjunction with analgesics to obtain pain relief. According to the lateral traditional surgical approach, there are two main goals for maintaining proper alignment of S.P.s operative leg. What are they, and how are they achieved? (2 pts) The client and the family must be fully aware of positions and activities that predispose the client to dislocation (greater than 90 degrees of flexion, adduction, or internal rotation). Many daily activities may reproduce these positions, including putting on shoes and socks, crossing the legs or feet while seated, assuming the side-lying position incorrectly, standing up or sitting down while the body is flexed relative to the chair, and sitting on low seats, especially low toilet seats. Until the soft tissue surrounding the hip has healed sufficiently to stabilize the prosthesis, usually for at least 6 weeks, these activities must be avoided. Use elevated toilet seat Place chair inside shower or tub and remain seated while washing Use pillow between legs for first 8 weeks after surgery when lying on the side allowed by surgeon or when supine Keep hip in neutral, straight position when sitting, walking, or lying Notify surgeon if severe pain, deformity, or loss of function occurs Postoperative wound infection is a concern for S.P. Describe what you would do to monitor her for a wound infection. (4 pts) Redness (rubor, hyperemia from vasodilation), heat (colour, increased metabolism at inflammatory site), pain (colour change in pH; change in local ionic concentration; nerve stimulation by chemicals (e.g.,histamine, prostaglandins; pressure from fluid exudate), swelling (tumour, fluid shift to interstitial spaces; fluid exudate accumulation), edge approximation, odor, type of exudate. Vital signs, WBC. Taking S.P.s RA into consideration: what interventions should be implemented to prevent complications secondary to immobility? (6 pts) The physiotherapist usually supervises active-assistance exercises for the affected extremity and ambulation when the surgeon permits it. Ambulation usually begins on the first postoperative day. The nurse in collaboration with the physiotherapist monitors the clients ambulation status. The ambulating client should pick up the feet rather than shuffling them so that muscular contraction is maximized. When confined to bed, the client should alternately flex and extend the legs. When the client is sitting in a chair or lying in bed, there should be no pressure to impede venous flow through the popliteal space. Crossed legs, pillows behind the knees, and extreme elevation of the knee gatch must be avoided. Some surgeons routinely prescribe use of elastic stockings or mechanical aids such as sequential compressive devices to stimulate and enhance the massaging and milking actions that are transmitted to the veins when leg muscles contract. The nurse must remember that these aids are usel ess if the legs are not exercised and may actually impair circulation if the legs remain inactive or if the devices are sized or applied improperly. When in use, elastic stockings must be removed and reapplied at least twice daily for skin care and inspection. The skin of the heels and posttibial areas is particularly susceptible to increased pressure and breakdown. The use of unfractionated heparin (UH) or low-molecular weight heparin (LMWH) is a prophylactic measure for venous thrombosis and pulmonary embolism. Advantages of LMWH over UH include (1) less major bleeding, (2) decreased incidence of thrombocytopenia, (3) better absorption, (4) longer duration of action, (5) as effective or more effective, and (6) no laboratory monitoring required. A primary nursing responsibility is the identification of clients at risk for the development of pressure ulcers and implementing pressure ulcer prevention strategies for those identified as being at risk. Prevention remains the best treatment for pressure ulcers. Devices such as support surfaces, special transfer equipment, and heel boots are useful in reducing pressure and shearing force. However, they are not adequate substitutes for frequent repositioning. The clients position should be changed every 1 to 2 hours to allow full chest expansion and increase perfusion of both lungs. Ambulation, not just sitting in a chair, should be aggressively carried out as soon as physician approval is given. Adequate and regular analgesic medication should be provided because incisional pain often is the greatest deterrent to client participation in effective ventilation and ambulation. The client should also be reassured that these activities will not cause the incision to separate. Adequate hydration, either parenteral or oral, is essential to maintain the integrity of mucous membranes and to keep secretions thin and loose for easy expectoration. Deep breathing and coughing techniques help the client prevent alveolar collapse and move respiratory secretions to larger airway passages for expectoration. The client should be assisted to breathe deeply 10 times every hour while awake. The use of an incentive spirometer is helpful in providing visual feedback of respiratory effort. The nurse should teach the client to use an incentive spirometer, which involves the following: inhale into the mechanism, hold the ball for about 3 seconds, and then exhale. This procedure should be done 10 to 15 times, and then the nurse should encourage the client to cough. It is recommended that an incentive spirometer should be used every 2 to 3 hours while awake. Urinary tract infections are another risk for people who may spend long periods of time on their back. This can promote urinary stasis or stagnation in the flow of urine from the kidneys to the bladder, and thus, lead to infection. Prolonged immobility also causes an increase of minerals and salts to circulate in the blood that can promote the formation of kidney stones. Constipation is a common problem that may result from decreased physical activity. Other factors may aggravate bowel evacuation. These include loss of privacy and embarrassment if toilet assistance is needed; uncomfortable positioning while using the commode; excessive delay in elimination because of the inconvenience in going to the bathroom; and the unavailability of caregiver assistance if help is needed to use the commode. Bowel irregularity may produce abdominal discomfort, as well as cause loss of appetite. 11.In patients with RA, very often Prednisone is prescribed for a patient with an acute exacerbation. Which laboratory result will the nurse monitor to determine whether the medication has been effective?(1 pt) Blood glucose test Liver function tests C-reactive protein level Serum electrolyte levels Explain your answer (what does this test show?) Data on high-sensitivity C-reactive protein have been reported, elevated levels of C-reactive protein appear to correlate best with symptoms of pain and stiffness rather than extent or progression of disease. To detect inflammation and test for the activity of the disease; may be used to help differentiate osteoarthritis and RA; an increased level of CRP occurs in RA but not in osteoarthritis. 12.A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? (1 pt) The patients blood glucose is 165 mg/dL (9.2 mmol/L). The patient has no improvement in symptoms. The patient has experienced a recent 5-pound (2.3 kilogram) weight loss. The patients erythrocyte sedimentation rate (ESR) has increased. Prednisone is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Long-term side effects include Cushings syndrome insulin resistance (especially common with ACTH production outside the pituitary), leading to high blood sugar and insulin resistance which can lead to diabetes mellitus. Insulin resistance is accompanied by skin changes such as acanthosis nigricans in the axilla and around the neck, as well as skin tags in the axilla. 13.What predisposing factor, identified in S.P.s medical history, places her at risk for infection, bleeding, and anemia? (1 pt) Medication administration rabeprazole (Aciphex) 20 mg/day, *prednisone (Deltasone) 5 mg/day, and *methotrexate (Amethopterin) 2.5 mg/wk History of upper gastrointestinal bleed in 1993, and had coronary artery disease with a coronary artery bypass graft 9 months ago 50-pack-year smoking history 14.Briefly discuss S.P.s nutritional needs. (2 pts) As a person grows older, there are decreases in lean body mass (the metabolically active tissue), basal metabolic rate, and physical activity. Combined, these factors decrease the caloric needs for energy. The older person frequently reduces the consumption of needed protein, vitamins, and minerals and may take in empty calories, such as candy and pastries. When these factors are added to already existing medical problems, it is easy to see why poor dietary practices develop. In addition, poor dentition, ill-fitting dentures, anorexia, multiple losses affecting the social setting of meals, low income, and medical conditions involving the GI tract play a role in the type and amount of foods that are eaten. Socioeconomic factors are of critical importance when assessing the nutritional status of an older adult. The nurse must be aware of common medical and psychosocial factors in the older adult and should incorporate interventions for overcoming these problems in the plan of care. Some of the physiological changes associated with aging affect the nutritional status of older adults. The following changes are of particular interest: 1. Changes in the oral cavity (e.g., change in bite surfaces of the teeth, periodontal disease, drying of the mucous membranes of the mouth and tongue, poorly fitting dentures, decreased muscle strength for chewing, decreased number of taste buds, decreased saliva production). 2. Changes in digestion and motility (e.g., decreased absorption of cobalamin, vitamin A, and folic acid and decreased GI motility). 3. Changes in the endocrine system (e.g., decreased tolerance to glucose). 4. Changes in the musculoskeletal system (e.g., decreased bone density, degenerative joint changes). 5. Decrease in vision and hearing (e.g., procurement and preparation of food are more difficult). Certain illnesses that are more prevalent in the older population are considered to be diet related. These include atherosclerosis, osteoporosis, diabetes mellitus, and diverticulosis. Multiple drugs are often required to treat these and other common chronic illnesses of the older client. These drugs often have an adverse effect on the appetite of older adults, increasing the possibility of inadequate intake caused by anorexia. Interventions: Calcium and Vitamin D Older adults need more calcium and vitamin D to help maintain bone health. Have three servings of vitamin D-fortified low-fat or fat-free milk or yogurt each day. Other calcium-rich foods include fortified cereals and fruit juices, dark green leafy vegetables and canned fish with soft bones. If you take a calcium supplement or multivitamin, choose one that contains vitamin D. Vitamin B12 Many people older than 50 do not get enough vitamin B12. Fortified cereal, lean meat and some fish and seafood are sources of vitamin B12. Ask your doctor or a registered dietitian nutritionist if you need a vitamin B12 supplement. Fiber Eat more fiber-rich foods to stay regular. Fiber also can help lower your risk for heart disease, control your weight and prevent Type 2 diabetes. Eat whole-grain breads and cereals, and more beans and peas along with fruits and vegetables which also provide fiber. Potassium Increasing potassium along with reducing sodium (salt) may lower your risk of high blood pressure. Fruits, vegetables and low-fat or fat-free milk and yogurt are good sources of potassium. Also, select and prepare foods with little or no added salt. 15.Explain four teaching points you can teach S.P. to help her protect herself from infection related to medication-induced immunosuppression. (4 pts) For older adult clients, the rate of HAI is 2 to 3 times higher than for younger clients. Age-related changes of decreased immunocompetence, the presence of comorbidities, and an increase in disability all contribute to higher infection rates. Infections common in older adults include pneumonia, urinary tract infections, skin infections, and TB (Furman et al.). Infections in older adults often have atypical presentations, and cognitive and behavioural changes appear before alterations occur in laboratory values (Furman et al.). Suspicion of disease should typically begin when changes in ability to perform daily activities or in cognitive function occur. Fever should not be relied upon to indicate infection in older adults because many have lower core body temperatures and decreased immune responses. Interventions include: 1. Handle Prepare Food Safely Food can carry germs. Wash hands, utensils, and surfaces often when preparing any food, especially raw meat. Always wash fruits and vegetables. Cook and keep foods at proper temperatures. Dont leave food out refrigerate promptly. 2. Wash Hands Often 3. Clean Disinfect Commonly Used Surfaces Germs can live on surfaces. Cleaning with soap and water is usually enough. However, you should disinfect your bathroom and kitchen regularly. Disinfect other areas if someone in the house is ill. You can use an EPA certified disinfectant (look for the EPA registration number on the label), bleach solution, or rubbing alcohol. 4. Cough Sneeze Into Your Sleeve Dont Share Personal Items Avoid sharing personal items that cant be disinfected, like toothbrushes and razors, or sharing towels between washes. Needles should never be shared, should only be used once, and then thrown away

Incident in the Life of a Slave Girl :: essays papers

Incident in the Life of a Slave Girl No one ever questioned T.S. Eliot as to whether or not he is a human being. Harriet Jacobs is just as much of a person, but looked down upon as a possession, as an animal. T.S. Eliot: white, popular, praised. Harriet Jacobs: African-American, hidden, questioned. In comparing Incidents in the Life of a Slave Girl and T.S. Eliot?s ?The Fire Sermon? there lies a correlation between the two literary works. While T.S. Eliot never experienced the life of a slave, ?The Fire Sermon? alludes to white supremacy tainted with dirty scenery, while Harriet Jacobs describes a world where the color of skin can make you feel as if you hadn?t bathed in weeks. Religious references to scriptures also appear in both literary texts. While neither T.S. Eliot nor Jacobs preach religion, the presence of godliness and spirituality explain how different races use religion as a means of escape. Understanding the significance of the historical contexts that shape these works tell why Jacobs and Eliot write at this time and what difference it makes within the text itself. Historical contexts and the continuing literary value of texts mold the way in which they can be received and survive among competing authors. T.S. Eliot wrote during a time where slavery was illegal. It might have been common for African Americans to hold jobs that were looked upon as ?dirty work? such as being housemaids, cooks, etc. but the extent of brutality among African Americans and the work that they did was voluntary. Harriet Jacobs?s character, Linda Brent, had no such luck. When Incidents in the Life of a Slave Girl was written, Lincoln was president but slaves were still being beaten and housed in plantations. Almost overnight, T.S. Eliot?s works became infamous; Eliot being a white male poet rising to infinite proportions. With a Nobel Prize under his belt as well as other numerous merits, anyone who questions the validity of his writings will almost always be argued with. On the other hand, Harriet Jacobs faces what Rafia Zafar calls a ?double negative of black race and female gender?(). Incidents has not received any sort of awards for literature although the book cover itself states it as ?one of the most important books ever written documenting the traumas and horrors of slavery in the antebellum South?(). Jacobs?s novel has yet to be recognized as a ?

Elizabeth, the Monster and Patriarchy Essay

In Mary Shelley’s Frankenstein, some blatant parallels are made between Dr. Frankenstein’s adopted sister, Elizabeth, and the monster he created. Both of these innocent creatures, together represent all of mankind in their similarities and differences, Elizabeth being the picture of womanhood and goodness, the monster representing manhood and evil. Both Elizabeth and the monster belong to and structure their lives in terms of Dr. Frankenstein, leading to overall destruction and, ultimately demonstrating the dangerous properties of patriarchy, which Dr. Frankenstein embodies. Dr. Frankenstein begins his narrative, most logically, in telling the story of his childhood. Dr. Victor Frankenstein’s mother was a loving, benevolent woman, moved by the plight of the impoverished and forever doing all in her power to give charity to those in need. It was thus that she came across a poor Italian family with a flock of dirty children, one of them stood out, she was blond and fair and especially angelic. Victor’s mother decided that it was her duty to raise this blond girl as her own, or, rather, as Victor’s own. This girl was Elizabeth who is, in a way, given to Victor as a gift, and thus begins his unnatural relationship with power and creation; â€Å"On the evening previous to [Elizabeth] being brought to my home, my mother had said playfully, ‘I have a pretty present for my Victor-tomorrow he shall have it.’ And when, on the morrow, she presented Elizabeth to me as her promised gift, I, with childish seriousness, interpreted her words literally and looked upon Elizabeth as mine-mine to protect, love, and cherish.† (56) On her deathbed, Victor’s mother expresses her desire for the ultimate union of Victor and Elizabeth. The fate of Elizabeth is thus utterly dependent upon Victor’s, and Victor’s relationship with his fellow humans is forever grossly twisted due to his near ownership of Elizabeth. The arrangement of their odd marriage is never questioned by either one of them, and neither are ever able to repair their relationships with other people/beings, their experiences being so inhuman. In his college years, Victor develops a desire, and acquires the necessary knowledge, to actually create life. After just a couple of extremely productive years at the University, Dr. Frankenstein discoveries an amazing thing, he states in his narration; â€Å"After days and nights of incredible labor and fatigue, I succeeded in discovering the cause of generation and life; nay, more, I became myself capable of bestowing animation upon lifeless matter.† (51) But it was not enough for Dr. Frankenstein merely to know how to give life, he had to do it himself. His goal was far from modest, he planned to create not a frog or a fruit fly, but a man. Dr. Frankenstein was excited by the power of his act, he likened himself to god, â€Å"A new species would bless me as its creator and source: many happy and excellent natures would owe their being to me.† (52) Victor’s egotism and corollary want for power frame him in the classic definition of the Patriarch. He believes that whatever he creates will love and cherish his being for the mere fact of his being its creator, his word is the final word and the right word The being that Dr. Frankenstein creates is the monster of the novel, this monster is at once an independent being, and a possession. It is the beautiful being that Dr. Frankenstein longed would look up to its supreme creator with servile gratitude. Dr. Frankenstein did not fully understand how horrific was his deed, until it had been done, regarding his first glimpse at the now living creature, Frankenstein remarked, â€Å"How can I describe my emotions at this catastrophe, or how delineate the wretch whom with such infinite pains and care I had endeavored to form?† In the  monster’s first moment of consciousness, he stretched out his arm towards his creator, a sign of ultimate compassion and the gratitude for which Dr. Frankenstein had longed. Dr. Frankenstein responds by turning his back and running. Dr. Frankenstein embodies the irresponsible leader, the unfeeling man, the Patriarch with grand intentions but no means of the necessary compassion. During the time in which Dr. Frankenstein is away from home, studying in the University, he receives a multitude of letters from the longing Elizabeth, and replies to none. Elizabeth remains at home in Switzerland, fulfilling her womanly duties to the Frankenstein family, her only hope for future happiness lies in her marriage with Victor, for she is nothing without him. The power that Dr. Frankenstein holds over Elizabeth has striking similarities to the dynamic of power he described as desiring over his creations. The pattern of neglect that Frankenstein demonstrates first with Elizabeth, then with the monster does not seem to phase their unconditional, and unreasonable, love for him. Dr. Frankenstein does not think of Elizabeth as an equal, for she is a woman, and he does not think of the monster as even a man, for he created him. Within a Patriarchy, the government feels justified in its neglectful actions for it feels itself better than the women and low lifes over which it rules. Just as a population allows their government to proceed with its cruel deeds without question, so do Elizabeth and the monster initially turn a blind eye to the evil acts of Dr. Frankenstein. Elizabeth and the monster are not only similar in their actions relative to Dr. Frankenstein, but both seem to occupy quite the opposite end of the spectrum of humanity. Elizabeth is submissive and self-sacrificing. She is blond and fair-skinned and described as â€Å"angelic†. Elizabeth encompasses womanhood and goodness at once. The monster, on the other hand, ends up dedicating his life to the destruction of Dr. Frankenstein’s livelihood. The monster is ugly, the mere sight of him puts people into shock. The monster is a self described â€Å"fallen angel† and he even likens himself to Adam, the first man. Thus the monster encompasses evil and manhood at once. Elizabeth and the monster together represent all of man, the oppressed, the poor, the  ugly and the helpless victims of a system built to benefit a select few. While Dr. Frankenstein represents the ruling class, Elizabeth and the monster together represent the under-privileged ruled class. War is a classically male act. War is the tool and the game of the Patriarchy and the innocent civilians are its pawns. When Dr. Frankenstein oversteps the limits of human power, he takes control over things for which man should not be responsible, he states â€Å"Life and death appeared to me ideal bounds, which I should first break through.† In commencing a war, the Patriarch puts himself in charge of the lives and deaths of many men, an extremely unnatural act. When Dr. Frankenstein meddles with the natural limits of life and death, he is creating the chaos of war in his own life. The death and destruction which results from Dr. Frankenstein’s creation, the death of his younger brother William, Justine and Elizabeth, are merely examples of the multitude of unnecessary deaths caused by the Patriarchal wars. Just as many wars could have been prevented through simple negotiations, had it not been for the arrogance of one man with too much power, so too could have the destruction in Frankenstein have been prevented had Dr. Frankenstein merely conceded with the monster’s simple request, with which he ended his own narrative; â€Å"My companion must be of the same species and have the same defects. This being you must create.†(137). Had Dr. Frankenstein for once done something for someone other than himself, in this case, create a female companion for the monster, many lives could have been saved. Shelley was clearly making the statement that the absence of womanly compassion in government is what leads to unnecessary destruction in war. In creating a man, Dr. Frankenstein takes on, unnaturally, a woman’s role, it is thus that he can neglect Elizabeth, deeming her unnecessary. This is the biggest mistake at all. Just as Elizabeth, or any woman, was left out of the creation of this man, so has woman been neglected from the makings of governments and societal structures in Patriarchies everywhere. Elizabeth and the monster represent a balance that Dr. Frankenstein lacks, because he rejects everything feminine and human, he must bear the consequences. At the time this book was written, many technological advances were being made, discoveries in science were flourishing and scientists themselves were  gaining the highest forms of respect. Unfortunately, due to the style of government and power structures at the time, these incredible advances benefited everyone but women and the poor. Infant mortality was still very high and other health issues related to women were being utterly ignored by the scientific community, which seemed to have no place for femininity. Shelley displays this discrepancy in the novel first with the many deaths of mothers, Elizabeth’s mother, Dr. Frankenstein’s mother, Clerval’s mother and Justine’s mother all died relatively early on in the novel. While Dr. Frankenstein could create life, no one could seem to save a mother in childbirth or make food for a starving family. To emphasize the lack of female influence in science, Dr. Frankenstein completes the most womanly act there is, creation of life, without a woman. Dr. Frankenstein’s unnatural power over Elizabeth and the monster eventually lead to the destruction of them all. It is not long before the roles are reversed between the Doctor and the monster. While the monster is initially enslaved to the doctor, by the end of the novel the doctor believes himself to be the slave of the monster. It is Dr. Frankenstein’s arrogant, patriarchal ego that gets his true love killed, his power destroys his life. Dr. Frankenstein’s divergence from all that is feminine and human led to chaos for all. Because Dr. Frankenstein dedicates his life to vengeance against the monster for the murder of Elizabeth, he becomes the slave of both the monster and Elizabeth: the tables turned. In the last moments of Dr. Frankenstein’s life, he cries â€Å"Scoffing devil! Again do I vow vengeance; again do I devote thee, miserable fiend, to  torture and death. Never will I give up my search until he or I perish; and then with what ecstasy shall I join my Elizabeth and my departed friends, who even now prepare me for  the reward of my tedious toil and terrible pilgrimage.† (195) Just as conditions must sometimes reach their lowest point before the people  break into revolution, and their rulers never renounce their sins in life, so did the worst type of destruction have to occur before Dr. Frankenstein realized what his role must be. Mary Shelley lived in a time when a woman novelist was believed to be putting her name on her husband’s work, the advancement of technology ran beyond human interests and only the rich received some sort of security against sudden death and rampant disease. Shelley saw the chaos and destruction that resulted from unequal representation in a power-hungry, Patriarchal government. Elizabeth and the monster embody the missing aspects of this un-representative ruling class; compassion and humanity, it is the absence of these things that Shelley displays the horrific result of in her novel. Frankenstein is more than a ghost story, it is a social narrative and a political manifesto.

Handwriting a Letter Versus Sending an E-Mail Message

Versus Sending an E-mail Message Handwriting a letter is very similar yet different from sending an email. Since the dawn of man until around the sass's people have wrote letters. In the sass's when the home Internet was first available, people became so fond of e-mailing that handwriting letters quickly became a lost art. Handwriting a letter is more personal and slower. While sending an e-mail is faster, easier, and not as personal.Both forms f communication have the ability to tell someone something, and most people like receiving a letter whether handwritten or by e-mail. E-mailing someone Isn't as personal as handwriting a letter. If someone writes the president a letter he might actually take the time to sit down and read it. Handwriting the letter versus e-malign It to him lets him know someone actually took the time to sit down and think about what they were going to write.If they e-mail him most likely someone who works for helm will read It first and ask him If he wants to read It, and here are probably millions of people who e-mail him, so he probably wont read every single one. So, there might be a better chance if the letter is handwritten because it seems as if they really want the president to hear what they have to say. The time frame it takes to actually sit down and write a letter does take longer than e-mailing someone. If you were to e-mail someone you can use abbreviations such as † 101†³, â€Å"ward†, † be, and â€Å"TTYL†. Sing abbreviations like these are quicker, easier and more time efficient even though they may not be considered proper rammer. Although handwritten are not as short as e-mails they are most likely to have better grammar, and usually more detailed. When people get on the computer, they probably are doing more than one thing at a time so their e-mail Is short, If they are more focused on something else. If someone Is handwriting a letter they take the time to sit down and Just focus on that and more thoughts may come to their head to write down.So yes, e-mailing is more beneficial for time frames but it may not be beneficial to everything you want to say. Something that is similar about these two thing is they both get the message across. No matter if it takes an hour to write or five minutes to type, the recipient is still receiving a letter or e-mail. Also if the recipient received a fully detailed letter or an extremely short message, they may have not gotten everything you planned to say but they got the idea of what you were trying to say.It may take you two days to receive your letter in the mail rather than getting it by e-mail in ten minutes but either way you are still receiving it . People now may take advantage of e-malign because It Is faster and easier. It may be because people are too lazy to write a letter or they Just don't have time. Some people may just stick to handwriting letters because they don't like the idea of all the new technology Ana want t o stick to tenet 010 ways. Bettor ten Internet people only knew how to write letters by hand. In the end it comes down to what you prefer, e- mailing or handwriting a letter.