Fololio Mulagia Essay

In May of 2011 a Samoan schoolteacher by the name of Folole Muliaga was sent home from a New Zealand hospital suffering from a terminal illness called cardiomyopathy. Because, doctors believed she did not have much longer to live she was sent home with two oxygen tanks to help aid her with her illness. McNaughton (2006) states that on May 29 a contractor for Vircom EMS was sent by Mercury Energy to the Muliaga’s home to disconnect the electricity supply. Mrs. Muliaga pleaded with the contractor to keep the electricity because of her health condition but he disagreed. A few short hours later Mrs.  Muliaga would perish. Prior to the Muliaga’s electricity being disconnected, the family had an outstanding balance of $168. 00, and could not afford to pay the bill. The case of Folole Muliaga would later be broadcast around the world capturing the attention of many government officials. This paper will cover many aspects including but not limited to: the consequences and outcomes of the scenario, the illegal and unethical aspects of the Mercury Company, was the role of the coroner and police department justifiable, and lastly, what reforms and guidelines were put in place as a result of the devastating tragedy? Evaluate Ethical Behavior: The Historical Case of Folole Muliaga Folole Muliaga, a 44 year old terminally ill mother of four suffering from cardiomyopathy perished after not being able to pay a $168. 00 electricity bill. As a result of Mrs. Muliaga sickness she was unable to continue her teaching career which brought in the majority of the household income. Johnston (2007) states that Mercury Energy was unaware that disconnecting power to a South Auckland home could have potentially life-threatening consequences. The resulted consequence was too harsh; to disconnect the electricity given that Mrs. Muliaga was just released from the hospital days earlier. The major price Mrs. Muliaga paid was dying 3 hours after the electricity was disconnected from her home. The family of Mrs. Muliaga would later dispute that the bill was not overdue, and that it was actually due days later. Bennett (2007) states that Folole’s husband actually made a partial payment on May 17 and would make another payment a few days later. The Mercury Energy contractor who disconnected the power says he was unaware that Mrs. Muliaga depended on oxygen tanks to live. What’s disturbing is that the Muliaga family states that when the ontractor arrived, Mrs. Muliaga invites him in and thourgly explains to him her health circumstances. She begins to plead with him not to disconnect the electricity, but he is not being attentive to her needs. He states he is simply doing his job, and that she must contact Mercury Energy to have the electricity restored. Although health professionals who treated the victim said her health problems had tremendously worsened over the past few months, does not make it morally nor ethically factual for the company to not hear the concerns of its customers. After the incident went ational the general manager for Mercury Energy stated that he was sure the company was not at fault for Mrs. Muliaga’s death. Cleve (2007) He contended: I’m confident that the processes we have put, the communications we had with the customer, were very clear about the circumstances that would happen. The general manager’s arrogance toward Muliaga’s death clearly shows his lack of concern and unethical behavior. His thoughts are that the company done nothing immorally or illegally wrong. In the case of Folole Muliaga there was almost a trial by media, pressuring Mercury to change how they conduct business with customers who ave severe medical conditions. A company’s culture is the biggest element of how it handles difficult situations. Companies no matter how large or small should have a value statement that aids them on what is considered ethical behavior. The actions of Mercury Energy were illegal in the eyes of many consumers and shareholders around the world. It’s very bothersome and also reality that individuals who occupy senior level managenet roles does not uphold the standards and intergrity when it comes to satisfying the needs of customers. Meredith (2007) says the behavior of Mercury Energy top xecutives serves to do no more than confirm just about every negative stereotype there is about impersonal, arrogant, and greedy corporates. What makes Folole’s story so alarming is that Mercury Energy is a state owned enterprise, which means the taxpayers solely, owns the company. Research states that Jones (1991) a moral issue is present when a person’s actions, when freely performed, may harm or benefit others. It’s imperative to know that many judgments are moral decisions because they have a moral component, such as the case of Folole Muliaga. The actions that took place in Mrs. Muliaga’s home was horribly illegal and unethical, because the situation was not investigated thourghly. If the contractor would have taken five minutes to contact someone about Mrs. Muliaga’s severe health condition her life probably could have been prolonged. The contractor’s irrational behavior to further assist the family is what makes this situation so demoralizing. A few weeks after Folole’s Muliaga’s death, Police announced that there was no evidence that did not point to Mercury Energy nor the contractor’s that they were at fault for Mrs. Muliaga’s death. After Folole’s death the family expressed that the Police department showed lack of â€Å"Cultural Awareness† and had â€Å"institutionalized racism†. Bridgeman (2010) Coroner Gordon Matenga concluded that Mrs. Muliaga died of natural causes but, an arrhythmia caused by morbid obesity and that the cessation of oxygen therapy and stress arising from the fact of the disconnection (as opposed to the way in which the power was disconnected) have contributed to her death. To agree with the coroner’s report individuals would really have to reexamine Folole’s case. Certainly, the victim had health issues that contributed to her death. But, the question we must ask ourselves is that if Mrs. Muliaga’s electricity was never turned off would she have still perished a few hours later. Many of us would answer the question by saying no, she would still be alive. In many of our thoughts and private belief’s we would say that Mercury Energy is responsible for her death. Summary: The Folole’s Muliaga’s story should have been an eye opener for all major corporations. Many companies today do not follow Corporate Social Responsibility. Many top managers and executives are simply in the business to make a large profit off of its shareholders and onsumers. Organizations have to reexamine the culture, morals, and values of why they are in business. Meredith (2007) In the case of Mercury Energy, those needs should have been understood to include the cultural and economic issues of a Samoan family struggling to make a go of their lives in New Zealand and to have been deserving of care and respect in addressing what turned out to be the life threatening issue of the discontinuation of their electricity supply. A variety of theoretical perspectives have been established to support researchers and most mportantly managers on social issues. These concepts would help organizations to understand the importance of having values and morals when it comes to dealing with the public. The social life cycle theory was used to analyze the Mercury Energy case. Ackerman (1975) found that, in general, the responsiveness of business organizations to social issues progresses through a three-phase trajectory; policy, learning, and commitment. Most of us who are familiar with the Muliaga case would say that the company was in refutation about the Muliaga issue.

Vascular Sounds, Abdominal,

The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical, and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Nevertheless, they can’t be considered absolute and universal recommendations. For individual applications, all recommendations must be considered in light of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light of the latest package-insert information. The authors and publisher isclaim any responsibility for any adverse effects resulting from the suggested procedures, from any undetected errors, or from the reader’s misunderstanding of the text.  © 2011 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanic al, photocopy, recording, or otherwise—without prior written permission of the publisher, except for brief quotations embodied in critical articles and reviews and testing and evaluation materials provided by publisher to instructors hose schools have adopted its accompanying textbook. Printed in China. For information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 323, Ambler, PA 19002-2756. Derived from American Gothic, 1930 by Grant Wood. All rights reserved by the estate of Nan Wood Graham/Licensed by VAGA, New York, NY. The publishers have made every effort to obtain permission from the copyright holders to use borrowed material. If any material requiring permission has been overlooked, the publishers will be pleased to make the necessary arrangements at the first opportunity. HAIV020410 Library of Congress Cataloging-in-Publication DataHealth assessment made incredibly visual!. —2nd ed. p. ; cm. —(Incredibly visual) Includes bibliographic al references and index. ISBN 978-1-60547-973-6 (alk. paper) 1. Physical diagnosis—Atlases. 2. Physical diagnosis—Handbooks, manuals, etc. I. Series: Incredibly visual. [DNLM: 1. Nursing Assessment—methods— Atlases. 2. Nursing Assessment—methods— Handbooks. 3. Physical Examination— methods—Atlases. 4. Physical Examination— methods—Handbooks. WY 49 H434 2011] RT48. H448 2011 616. 07'54—dc22 ISBN13 978-1-60547-973-6 ISBN10 1-60547-973-X (alk. paper) 2009049443 Staff Publisher Chris Burghardt Clinical Director Joan M. Robinson, RN, MSNProduct Manager Diane Labus Clinical Project Manager Beverly Ann Tscheschlog, RN, MS Editor Jaime Stockslager Buss, MSPH, ELS Copy Editor Karen Comerford Design Coordinator Joan Wendt Illustrator Bot Roda Associate Manufacturing Manager Beth J. Welsh Editorial Assistants Karen J. Kirk, Jeri O'Shea, Linda K. Ruhf Contents iii A work of art iv Contributors and consultants vi 1 Fund amentals 1 2 Skin, hair, and nails 11 3 Eyes and ears 27 4 Nose, mouth, throat, and neck 49 5 Respiratory system 67 6 Cardiovascular system 87 7 Breasts and axillae 113 8 Gastrointestinal system 127 9 Musculoskeletal system 147 10 Neurologic system 171 1 Genitourinary system 193 Selected references 239 Credits 240 Index 242 12 Pregnancy 213 iv Contributors and consultants I’m so excited to be here today! The gallery is opening its new exhibit, Health Assessment Made Incredibly Visual. best picture outside the norm take note I hear it’s a masterpiece that’s guaranteed to inspire top-notch assessment skills. It’s even more extraordinary than I expected. outside the norm take note v The vividly detailed illustrations and photographs of abnormal findings are definitely â€Å"Outside the norm. † And what chiaroscuro! And I’m certainly going to â€Å"Take note† of this piece. You an tell that it captures lifelike charts that illustrate the correct ways to document assessment findings. If this collection were a movie, it would have â€Å"Best picture† written all over it. The graphic depictions of best assessment practices that appear throughout are unique and innovative. All-in-all, I find this a visually stunning and exciting new work. It has certainly inspired me to master health assessment. best picture vi Contributors and consultants Nancy Berger, RN, MSN, BC, CNE Program Coordinator Middlesex County College Edison, N. J. Marsha L. Conroy, RN, BA, MSN, APN Nurse Educator Indiana Wesleyan University MarionChamberlain College of Nursing Columbus, Ohio Roseanne Hanlon Rafter, RN, MSN, GCNS, BC Director of Nursing Professional Practice Chestnut Hill Hospital Philadelphia, Pa. Dana Reeves, RN, MSN Assistant Professor University of Arkansas—Fort Smith Denise Stefancyk, RN, BSN, CCRC Clinical Specialist University of Massachusetts Medical Center Worcester Allison J. Terry, RN, PhD Director, Center for Nursi ng Alabama Board of Nursing Montgomery Leigh Ann Trujillo, RN, BSN Clinical Educator St. James Hospital and Health Centers Olympia Fields, Ill. Rita M. Wick, RN, BSN Simulation Coordinator Berkshire Health Systems Pittsfield, Mass.Sharon E. Wing, RN, PhD(C), CNL Associate Professor Cleveland (Ohio) State University Lisa Wolf, RN, MS, CMSRN Clinical Educator Mount Carmel West Columbus, Ohio Health history 2 Physical assessment 6 Documentation 9 Vision quest 10 Ready. Action! Health history Interviewing tips To make the most of your patient interview, create an environment in which the patient feels comfortable. Also, use the following techniques to ensure effective communication. Fundamentals  ¦ Provided by the patient, or â€Å"subject†  ¦ Verified only by the patient  ¦ Include statements such as â€Å"My head hurts† or â€Å"I have trouble sleeping† Subjective data Are observed  ¦ Are verifiable  ¦ Include findings such as a red, swollen arm in a pat ient with arm pain Objective data The success of your patient interview depends on effective communication.  Select a quiet, private setting.  Choose terms carefully and avoid using medical jargon.  Speak slowly and clearly.  Use effective communication techniques, such as silence, facilitation, confirmation, reflection, and clarification.  Use open-ended and closed-ended questions as appropriate.  Use appropriate body language.  Confirm patient statements to avoid misunderstanding.  Summarize and conclude with â€Å"Is there anything else?         2 Fundamentals All assessments involve collecting two kinds of data: objective and subjective. The health history gathers subjective data about the patient. Health history 3 Components of a complete health history Biographical data Name __________________________________________ Address ________________________________________ Date of birth ____________________________________ Advance directive explained:  Yes  No Livin g will on chart:  Yes  No Name and phone numbers of next of kin: NAME RELATIONSHIP PHONE # ________________________________________________ ________________________________________________Chief complaint History of present illness ________________________________________________ ________________________________________________ Current medications DRUG AND DOSE FREQUENCY LAST DOSE ________________________________________________ ________________________________________________ Medical history Allergies  Tape  Iodine  Latex  No known allergies  Drug: _________________________________________  Food: _________________________________________  Environmental: _________________________________  Blood reaction: _________________________________  Other: _________________________________________ Childhood illnessesDATE ________________________________________________ ________________________________________________ Previous hospitalizations (Illness, accident or injury, surgery, bl ood transfusion) DATE Health problems Yes No Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blood problem (anemia, sickle cell, clotting, bleeding). . . . Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . Eye problem (cataracts, glaucoma) . . . . . . . . . . . . Heart disease (heart failure, MI, valve disease) Hiatal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . Kidney problem . . . . . . . . . . . . . . . . . . . . . . . . . Liver problem . . . . . . . . . . . . . . . . . . . . . . . . . . . Lung problem (asthma, bronchitis, emphysema, pneumonia, TB, shortness of breath) . . . . . . . . . . . . Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thyroid problem . . . . . . . . . . . . . . . . . . . . . . . . . Ulcers (duodenal, peptic). . . . . . . . . . . . . . . . . . . . Psychological disorder . . . . . . . . . . . . . . . . . . . Obstetric history (females) Last menstrual period _____________________________ Gravida __________ Para ___________ Menopause Yes No Psychosocial history Coping strategies _________________________________________________ Feelings of safety ________________________________________________ Social history Smoker No Yes (# packs/day _____ # years ___ ) Alcohol No Yes (type ________ amount/day ___ ) Illicit drug use No Yes (type ____________ ) Religious and cultural observances ________________________________________________ Activities of daily living Diet and exercise regimen _________________________Elimination patterns _______________________________ Sleep patterns ____________________________________ Work and leisure activities _________________________ Use of safety measures (seat belt, bike helmet, sunscreen) ______________________ Health mainten ance history DATE Colonoscopy ____________________________________ Dental examination _______________________________ Eye examination _________________________________ Immunizations ___________________________________ Mammography __________________________________ Family medical history Health problem Yes No Who (parent, grandparent, sibling) Ask about the patient’s family edical history, including history of diabetes or heart disease. Ask about the patient’s feelings of safety to help identify physical, psychological, emotional, and sexual abuse issues. Arthritis . . . . . . . . . . . . Cancer . . . . . . . . . . . . . Diabetes mellitus . . . . . Heart disease (heart failure, MI, valve disease) . . Hypertension . . . . . . . . Stroke . . . . . . . . . . . . . Be sure to include prescription drugs, over-the-counter drugs, herbal preparations, and vitamins and supplements. 4 Fundamentals During the final part of the health history, ask about each body structure and syst em to make sure that important ymptoms weren’t missed. Start at the top of the head and work your way down to the toes. Head Psychological status Neck Endocrine system Breasts and axillae Gastrointestinal system Reproductive system General health Neurologic system Eyes, ears, and nose Mouth and throat Skin, hair, and nails Cardiovascular system Respiratory system Hematologic system Urinary system Musculoskeletal system Review of structures and systems Health history 5 Evaluating a symptom Perform a focused physical examination to quickly determine the severity of the patient’s condition. Take a thorough history. Note GI disorders that can lead to abdominal distention.Thoroughly examine the patient. Observe for abdominal asymmetry. Inspect the skin, auscultate for bowel sounds, percuss and palpate the abdomen, and measure abdominal girth. My stomach gets bloated. Your patient is vague in describing his chief complaint. Using your interviewing skills, you discover his pr oblem is related to abdominal distention. Now what? This flowchart will walk you through what to do next. Take a brief history. Intervene appropriately to stabilize the patient, and notify the doctor immediately. Review your findings to consider possible causes, such as cancer, bladder distention, cirrhosis, heart failure, and astric dilation. After the patient’s condition stabilizes, review your findings to consider possible causes, such as trauma, large-bowel obstruction, mesenteric artery occlusion, and peritonitis. Devise an appropriate care plan. Position the patient comfortably, administer ordered analgesics, and prepare the patient for diagnostic tests. Form a first impression. Does the patient’s condition alert you to an emergency? For example, does he say the bloating developed suddenly? Does he mention that other signs or symptoms occur with it, such as sweating and light-headedness? (Indicators of hypovolemia) Yes NoAsk the patient to identify the symptom th at’s bothering him. Do you have any other signs or symptoms? Evaluate your findings. Are emergency signs or symptoms present, such as abdominal rigidity and abnormal bowel sounds? Yes No 6 Fundamentals Physical assessment  ¦ Cotton balls  ¦ Gloves  ¦ Metric ruler (clear)  ¦ Near-vision and visual acuity charts  ¦ Ophthalmoscope  ¦ Otoscope  ¦ Penlight  ¦ Percussion hammer  ¦ Paper clip  ¦ Scale with height measurement  ¦ Skin calipers  ¦ Specula (nasal and vaginal)  ¦ Sphygmomanometer  ¦ Stethoscope  ¦ Tape measure (cloth or paper)  ¦ Thermometer  ¦ Tuning fork  ¦ Wooden tongue blade Assessment toolsAssemble the necessary tools for the physical assessment. Then perform a general survey to form your initial impression of the patient. Obtain baseline data, including height, weight, and vital signs. This information will direct the rest of your assessment. Measuring blood pressure  ¦ Position your patient with his upper arm at heart level an d his palm turned up.  ¦ Apply the cuff snugly, 1 (2. 5 cm) above the brachial pulse.  ¦ Position the manometer at your eye level.  ¦ Palpate the brachial or radial pulse with your fingertips while inflating the cuff.  ¦ Inflate the cuff to 30 mm Hg above the point where the pulse disappears. Place the bell of your stethoscope over the point where you felt the pulse, as shown in the photo. (Using the bell will help you better hear Korotkoff’s sounds, which indicate pulse. )  ¦ Release the valve slowly and note the point at which Korotkoff’s sounds reappear. The start of the pulse sound indicates the systolic pressure.  ¦ The sounds will become muffled and then disappear. The last Korotkoff’s sound you hear is the diastolic pressure. best picture Got your tools? Good. Let’s get to work! Tips for interpreting vital signs  ¦ Analyze vital signs at the same time. Two or more abnormal values may provide clues to the patient’s problem.For example, a rapid, thready pulse along with low blood pressure may signal shock.  ¦ If you obtain an abnormal value, take the vital sign again to make sure it’s accurate.  ¦ Remember that normal readings vary with the patient’s age. For example, temperature decreases with age, and respiratory rate can increase with age.  ¦ Remember that an abnormal value for one patient may be a normal value for another, which is why baseline values are so important. Physical assessment 7 Physical assessment techniques When you perform the physical assessment, you’ll use four techniques: inspection, palpation, percussion, and auscultation.Use these techniques in this sequence except when you perform an abdominal assessment. Because palpation and percussion can alter bowel sounds, the sequence for assessing the abdomen is inspection, auscultation, percussion, and palpation. 1 Inspection Inspect each body system using vision, smell, and hearing to assess normal conditions and deviations. Observe for color, size, location, movement, texture, symmetry, odors, and sounds as you assess each body system. 2Palpation Palpation requires you to touch the patient with different parts of your hands, using varying degrees of pressure. Because your hands are your tools, keep your fingernails hort and your hands warm. Wear gloves when palpating mucous membranes or areas in contact with body fluids. Palpate tender areas last. Types of palpation Light palpation  ¦ Use this technique to feel for surface abnormalities.  ¦ Depress the skin 1/2 to 3/4 (1. 5 to 2 cm) with your finger pads, using the lightest touch possible.  ¦ Assess for texture, tenderness, temperature, moisture, elasticity, pulsations, superficial organs, and masses. Deep palpation  ¦ Use this technique to feel internal organs and masses for size, shape, tenderness, symmetry, and mobility.  ¦ Depress the skin 11/2 to 2 (4 to 5 cm) with firm, deep pressure. Use one hand on top of the other to exert firmer pressure, if needed. 8 Fundamentals 3Percussion Percussion involves tapping your fingers or hands quickly and sharply against parts of the patient’s body to help you locate organ borders, identify organ shape and position, and determine if an organ is solid or filled with fluid or gas. 4Auscultation Auscultation involves listening for various breath, heart, and bowel sounds with a stethoscope. Types of percussion Direct percussion This technique reveals tenderness; it’s commonly used to assess an adult patient’s sinuses. Here’s how to do it:  ¦ Using one or two fingers, tap irectly on the body part.  ¦ Ask the patient to tell you which areas are painful, and watch his face for signs of discomfort. Indirect percussion This technique elicits sounds that give clues to the makeup of the underlying tissue. Here’s how to do it:  ¦ Press the distal part of the middle finger of your nondominant hand firmly on the body part.  ¦ Keep th e rest of your hand off the body surface.  ¦ Flex the wrist of your dominant hand.  ¦ Using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger touches the patient’s skin.  ¦ Listen to the sounds produced. Getting ready Provide a quiet environment.  ¦ Make sure the area to be auscultated is exposed. ( Auscultating over a gown or bed linens can interfere with sounds. )  ¦ Warm the stethoscope head in your hand.  ¦ Close your eyes to help focus your attention. How to auscultate  ¦ Use the diaphragm to pick up high-pitched sounds, such as first (S1) and second (S2) heart sounds. Hold the diaphragm firmly against the patient’s skin, enough to leave a slight ring on the skin afterward.  ¦ Use the bell to pick up low-pitched sounds, such as third (S3) and fourth (S4) heart sounds. Hold the bell lightly against the patient’s skin, just enough to form a seal.Holding the bell too firmly causes th e skin to act as a diaphragm, obliterating low-pitched sounds.  ¦ Listen to and try to identify the characteristics of one sound at a time. Documentation 9 Documentation Get to know your stethoscope Your stethoscope should have snug-fitting ear tips, which you’ll position toward your nose. The stethoscope should also have tubing no longer than 15 (38. 1 cm) with an internal diameter not greater than 1/8 (0. 3 cm). It should have both a dia phragm and bell. The parts of a stethoscope are labeled below. Ear tips Binaurals (ear tubes) Tension bar Tubing Bell Stem Diaphragm Headset ChestpieceDocumenting initial assessment findings Here’s an example of how to record your findings on an initial assessment form. take note Name Age _______ Sex ______ Height ________ Weight ________ T ______ P ___ R ___ B/P (R) ____________ (L) _____________ Room _____________________ Admission time ____________ Admission date ____________ Doctor ____________________ Admitting diagnosis: __ _________________________ ___________________________ ___________________________ ___________________________ Patient’s stated reason for hospitalization ______________ ___________________________ ___________________________ Allergies ___________________ __________________________ ___________________________ Current medications ________ Name Dosage Last taken _______________________________ _______________________________ _______________________________ _______________________________ General survey _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Henry Gibson 55 M 163 cm 57 kg 37  C 76 14 150/90 sitting 148/88 sitting 328 0800 4 -28-10 Manzel Pneumonia â€Å"To get rid of the pneumonia† PenicillinCodeine None In no acute distress. Slender, alert, and well-groomed. Communicates well. Make s eye contact and expresses appropriate concern throughout exam. C. Smith, RN General information Identify the assessment technique being used in each illustration. Show and tell Unscramble the words at right to discover terms related to fundamentals of assess ment. Then use the circled letters from those words to answer the question posed. My word! Answers: Show and tell 1. Indirect percussion, 2. Deep palpation; My word! 1. Auscultation, 2. Subjective data, 3. Chief complaint, 4. Palpation; Question: Abdomen 10 1. 2. 1. tunicaastolu 2. ivateacub jest 3. place inchmotif 4. aplaintop Answer: Question: Assessment of which body part does not follow the usual sequence? Anatomy 12 Assessment 14 Skin abnormalities 16 Hair abnormalities 24 Nail abnormalities 25 Vision quest 26 Quiet on the set. The assessment is about to begin. Anatomy 12 Skin, hair, and nails SkinSkin, hair, nails The skin covers and protects the internal structures of the body. It consists of two distinct layers: the ep idermis and the dermis. Subcutaneous tissue lies beneath these layers. Epidermis  ¦ Outer layer  ¦ Made of squamous epithelial tissue Dermis  ¦ Thick, deeper layer  ¦ Consists of connective issue and an extracellular material (matrix), which contributes to the skin’s strength and pliability  ¦ Location of blood vessels, lymphatic vessels, nerves, hair follicles, and sweat and sebaceous glands Subcutaneous tissue  ¦ Beneath dermis and epidermis  ¦ Consists mostly of adipose and other connective tissues Stratum corneum Pore of sweat gland Free nerve ending Eccrine sweat gland Hair bulb Sensory nerve fibers Autonomic nerve fibers Artery Vein Anatomy 13 Hair Hair is formed from keratin produced by matrix cells in the dermal layer of the skin. Each hair lies in a hair follicle. Hair shaft Sebaceous gland Arrector pili muscleHair follicle Sensory nerve fibers Hair bulb  ¦ Contains melanocytes Hair papilla  ¦ Consists of a loop of capillaries  ¦ Provides nourishm ent to hair Nails Nails are formed when epidermal cells are converted into hard plates of keratin. Hyponychium Nail plate Lateral nail fold Lunula Eponychium Nail root Nail matrix Hair bulb Matrix cell  ¦ Produces hair Cuticle cells Inner root sheath Outer root sheath Capillary in hair papilla Melanocyte  ¦ Determines hair color What is the matrix? The area of the dermis on which the nail rests. 14 Skin, hair, and nails Assessment To assess the skin, hair, and nails, use inspection and palpation. SkinObserve the skin’s overall appearance. Then inspect and palpate the skin area by area, focusing on color, moisture, texture, turgor, and temperature. Examine the conjunctivae, palms, soles, buccal mucosa, and tongue. Look for dull, dark color. Examine the area for decreased color and palpate for tightness. Palpate the area for warmth. Examine the sclerae and hard palate in natural, not fluorescent, light if possible. Look for a yellow color. Examine the sclerae, conjunctivae, buccal mucosa, lips, tongue, nail beds, palms, and soles. Look for an ashen color. Examine areas of lighter pigmentation such as the abdomen. Look for tiny, purplish red ots. Palpate the area for skin texture changes. Cyanosis Edema Erythema Jaundice Pallor Petechiae Rashes Color Look for localized areas of bruising, cyanosis, pallor, and erythema. Check for uniformity of color and hypopigmented or hyperpigmented areas. Moisture Observe the skin’s moisture content. The skin should be relatively dry, with a minimal amount of perspiration. Be sure to wear gloves during your examination of the skin, hair, and nails. Detecting color variations in dark-skinned people Assessment 15 Texture and turgor Inspect and palpate the skin’s texture, noting its thickness and mobility. It should look smooth and be intact.To assess skin turgor in an infant, grasp a fold of loosely adherent abdominal skin between your thumb and forefinger and pull the skin taut. Then release the skin. Th e skin should quickly return to its normal position. If the skin remains tented, the infant has poor turgor. Temperature Palpate the skin bilaterally for temperature using the dorsal surface of your hands and fingers. The dorsal surface is the most sensitive to temperature changes. Warm skin suggests normal circulation; cool skin, a possible underlying disorder. Assessing skin turgor in an adult Gently squeeze the skin on the forearm or sternal rea between your thumb and forefinger, as shown. If the skin quickly returns to its original shape, the patient has normal turgor. If it returns to its original shape slowly over 30 seconds or maintains a tented position, as shown, the skin has poor turgor. best picture Normal skin variations You may see normal variations in the skin’s texture and pigmentation. Such variations may include nevi, or moles, and freckles (shown below). 16 Skin, hair, and nails Lesion configurations Discrete Individual lesions are separate and distinct. Gro uped Lesions are clustered together. Dermatomal Lesions form a line or an arch and follow dermatome. Confluent Lesions merge so that discrete lesions are not visible or palpable. Lesion shapes Discoid Round or oval Annular Circular with central clearing Target (bull’s eye) Annular with central internal activity Hair When assessing the hair, note the distribution, quantity, texture, and color. Hair should be evenly distributed. Nails Examine the nails for color, shape, thickness, consistency, and contour. Nail color is pink in light-skinned people and brown in dark-skinned people. The nail surface should be slightly curved or flat and the edges smooth and rounded. Lesions When evaluating a lesion, you’ll need to classify t as primary (new) or secondary (a change in a primary lesion). Then determine if it’s solid or fluid-filled and describe its characteristics, pattern, location, and distribution. Include a description of symmetry, borders, color, configuration, diameter, and drainage. Skin abnormalities I know you’ll have these assessment skills nailed in no time! Lesion distribution Generalized — Distributed all over the body Regionalized — Limited to one area of the body Localized — Sharply limited to a specific area Scattered — Dispersed either densely or widely Exposed areas — Limited to areas exposed to the air or sun Intertriginous — Limited to reas where skin comes in contact with itself Skin abnormalities 17 outside the norm Types of skin lesions Fissure A painful, cracklike lesion of the skin that extends at least into the dermis Cyst A closed sac in or under the skin that contains fluid or semisolid material Papule A solid, raised lesion that’s usually less than 1 cm in diameter Vesicle A small, fluid-filled blister that’s usually 1 cm or less in diameter Bulla A large, fluid-filled blister that’s usually 1 cm or more in diameter Ulcer A craterlike lesion of th e skin that usually extends at least into the dermis Macule A small, discolored spot or patch on the skinWheal A raised, reddish area that’s commonly itchy and lasts 24 hours or less Pustule A small, pus-filled lesion (called a follicular pustule if it contains a hair) Nodule A raised lesion detectable by touch that’s usually 1 cm or more in diameter Documenting a skin lesion take note At 0820, pt. c/o right shoulder blade pain, 4/10 on a 0-10 scale. A closed, purulent lesion noted in right upper scapular region of back, approx. 1. 5 cm x 1 cm, with 3 cm surrounding area of erythema. T 100. 2 F. Call placed to Dr. Tomlin’s service at 0830. Angela Kessler, RN 4/15/10 0845 18 Skin, hair, and nails Benign versus cancerous lesionsLesions may be benign, such as a benign nevus, or mole. However, changes in an existing growth on the skin or a new growth that ulcerates or doesn’t heal could indicate cancer or a precancerous lesion. Types of skin cancer outside t he norm  ¦ Abnormal changes in keratinocytes  ¦ Can become squamous cell carcinoma Precancerous actinic keratosis  ¦ Abnormal growth of melanocytes in a mole  ¦ Can become malignant melanoma Dysplastic nevus Note the differences between benign and cancerous lesions.  ¦ Symmetrical, round, or oval shape  ¦ Sharply defined borders  ¦ Uniform, usually tan or brown color  ¦ Less than 6 mm in diameter  ¦ Flat or raisedBenign nevus  ¦ Abnormal changes in keratinocytes  ¦ Can become squamous cell carcinoma  ¦ Abnormal growth of melanocytes in a mole  ¦ Can become malignant melanoma Skin abnormalities 19 More severe Less severe  ¦ Begins as a firm, red nodule or scaly, crusted, flat lesion  ¦ Can spread if not treated Squamous cell carcinoma  ¦ Most common skin cancer  ¦ Usually spreads only locally Basal cell carcinoma  ¦ Can arise on normal skin or from an existing mole  ¦ If not treated promptly, can spread to other areas of skin, lymph nodes, or int ernal organs Malignant melanoma If you suspect a lesion may be malignant melanoma, observe for these haracteristics. memory board ABCDEs of malignant melanoma A = Asymmetrical lesion B = Border irregular C = Color of lesion varies with shades of tan, brown, or black and, possibly, red, blue, or white D = Diameter greater than 6 mm E = Elevated or enlarging lesion 20 Skin, hair, and nails Common skin disorders outside the norm Contact dermatitis is an inflammatory disorder that results from contact with an irritant. Primary lesions include vesicles, large oozing bullae, and red macules that appear at localized areas of redness. These lesions may itch and burn. Contact dermatitis Psoriasis is a chronic disease of marked pidermal thickening. Plaques are symmetrical and generally appear as red bases topped with silvery scales. The lesions, which may connect with one another, occur most commonly on the scalp, elbows, and knees. Psoriasis Occurring as an allergic reaction, urticaria appea rs suddenly as pink, edematous papules or wheals (round elevations of the skin). Itching is intense. The lesions may become large and contain vesicles. Urticaria (hives) Skin abnormalities 21 Mites, which can be picked up from an infested person, burrow under the skin and cause scabies lesions. The lesions appear in a straight or zigzagging line about 3/8 (1 cm) ong with a black dot at the end. Commonly seen between the fingers, at the bend of the elbow and knee, and around the groin, abdomen, or perineal area, scabies lesions itch and may cause a rash. Scabies Herpes zoster appears as a group of vesicles or crusted lesions along a nerve root. The vesicles are usually unilateral and appear mostly on the trunk. These lesions cause pain but not a rash. Herpes zoster Tinea corporis is characterized by round, red, scaly lesions that are accompanied by intense itching. These lesions have slightly raised, red borders consisting of tiny vesicles. Individual rings may connect to form atche s with scalloped edges. They usually appear on exposed areas of the body. Tinea corporis (ringworm) Once I burrow under the skin, I settle down and make myself comfortable. 22 Skin, hair, and nails Pressure ulcers Pressure ulcers are localized areas of skin breakdown that occur as a result of prolonged pressure. Necrotic tissue develops because the vascular supply to the area is diminished. Staging pressure ulcers You can use characteristics gained from your assessment to stage a pressure ulcer, as described here. Staging reflects the anatomic depth of exposed tissue. Keep in mind that if the wound contains necrotic issue, you won’t be able to determine the stage until you can see the wound base. outside the norm Suspected deep tissue injury  ¦ Maroon or purple intact skin or blood-filled blister  ¦ May be painful; mushy, firm, or boggy; and warmer or cooler than other tissue before discoloration occurs Stage I  ¦ Intact skin that doesn’t blanch  ¦ May differ i n color from surrounding area in people with darkly pigmented skin  ¦ Usually over a bony prominence  ¦ May be painful, firm or soft, and warmer or cooler than surrounding tissue Note: This stage shouldn’t be used to describe perineal dermatitis, maceration, tape burns, skin tears, or excoriation.Stage II  ¦ Superficial partial-thickness wound  ¦ Presents as a shallow, open ulcer without slough and with a red and pink wound bed Skin abnormalities 23 Stage III  ¦ Involves full-thickness wound with tissue loss and possibly visible subcutaneous tissue but no exposed muscle, tendon, or bone  ¦ May have slough but not enough to hide the depth of tissue loss  ¦ May be accompanied by undermining and tunneling Stage IV  ¦ Involves full-thickness skin loss, with exposed muscle, bone, and tendon  ¦ May be accompanied by eschar, slough, undermining, and tunneling Unstageable  ¦ Involves full-thickness tissue loss, with base of ulcer covered by slough nd yellow, tan, gray, green, or brown eschar  ¦ Can’t be staged until enough slough and eschar are removed to expose the wound base 24 Skin, hair, and nails Hair abnormalities Typically stemming from other problems, hair abnormalities can cause patients emotional distress. Among the most common hair abnormalities are alopecia and hirsutism. Alopecia occurs more commonly and extensively in men than in women. Diffuse hair loss, though commonly a normal part of aging, may occur as a result of pyrogenic infections, chemical trauma, ingestion of certain drugs, and endocrinopathy and other disorders. Tinea capitis, trauma, and ull-thickness burns can cause patchy hair loss. Alopecia Excessive hairiness in women, or hirsutism, can develop on the body and face, affecting the patient’s selfimage. Localized hirsutism may occur on pigmented nevi. Generalized hirsutism can result from certain drug therapy or from such endocrine problems as Cushing’s syndrome, polycystic ovary syndrome, a nd acromegaly. Hirsutism outside the norm Now â€Å"hair† this: Hair abnormalities may be caused by certain drugs or endocrine problems. Nail abnormalities 25 Nail abnormalities Although many nail abnormalities are harmless, some point to serious underlying problems.Nail abnormalities include clubbed fingers, splinter hemorrhages of the nail bed, and Muehrcke’s lines. outside the norm Splinter hemorrhages are reddish brown narrow streaks under the nails. They run in the same direction as nail growth and are caused by minor trauma. They can also occur in patients with bacterial endocarditis. Splinter hemorrhages Muehrcke's lines or leukonychia striata are longitudinal white lines that can indicate trauma but may also be associated with metabolic stress, which impairs the body from using protein. Muehrcke's lines Clubbed fingers can result from chronic tissue hypoxia. Normally, the angle between the ingernail and the point where the nail enters the skin is about 160 degr ees. Clubbing occurs when that angle increases to 180 degrees or more. Clubbed fingers Normal fingers Normal angle (160 degrees) Clubbed fingers Angle greater than 180 degrees Enlarged and curved nail Answers: Able to label 1. Epidermis, 2. Dermis, 3. Subcutaneous tissue, 4. Hair bulb, 5. Eccrine sweat gland; Rebus riddle The dorsal surface of the hand is most sensitive to temperature changes. 1. 2. 3. 4. 5. Identify the skin structures indicated on this illustration. Sound out each group of pictures and symbols to reveal terms that complete this assessment onsideration. Able to label? Rebus riddle 26 Anatomy 28 Assessment 31 Eye abnormalities 42 Ear abnormalities 46 Vision quest 48 Aye, aye, matey! I best be gettin’ along. They’re filming the eye and ear assessment down on Soundstage 3. 28 Eyes and ears Anatomy EyeEsye and ears The eyes are delicate sensory organs equipped with many extraocular and intraocular structures. Some structures are easily visible, whereas ot hers can only be viewed with special instruments, such as an ophthalmoscope. Extraocular structures The bony orbits protect the eyes from trauma. The eyelids (or pal pebrae), lashes, and lacrimal gland, punctum, canaliculi, and ac protect the eyes from injury, dust, and foreign bodies. Bony orbit Lacrimal gland  ¦ Pars orbitalis  ¦ Pars palpebralis Upper eyelid Lashes Lower eyelid Lacrimal punctum Lacrimal canaliculi Lacrimal sac Nasolacrimal duct Eye muscles Superior oblique muscle Superior rectus muscle Medial rectus muscle Lateral rectus muscle Inferior rectus muscle Inferior oblique muscle Anatomy 29 Intraocular structures The intraocular structures of the eye are directly involved in vision. The eye has three layers of tissue:  ¦ The outermost layer includes the transparent cornea and the sclera, which maintain the form and size of the eyeball. The middle layer includes the choroid, ciliary body, and iris. Pupil size is controlled by involuntary muscles in this region.  ¦ The innermost layer is the retina, which receives visual stimuli and sends them to the brain. Retinal structures: A closer view Superonasal arteriole and vein Optic disk Physiologic cup Arteriole Inferonasal arteriole and vein Vein Superotemporal arteriole and vein Fovea centralis Macular area Inferotemporal arteriole and vein Sclera Choroid Conjunctiva (bulbar) Ciliary body Cornea Lens Pupil Iris Anterior chamber (filled with aqueous humor) Posterior chamber (filled with aqueous humor) Schlemm’s canalVitreous humor Optic nerve Central retinal artery and vein Retina These structures are located in the posterior part of the eye, also called the fundus. They’re visible with an ophthalmoscope. 30 Eyes and ears Ear External ear The flexible external ear consists mainly of elastic cartilage. It contains the ear flap, also known as the auricle or pinna, and the auditory canal. This part of the ear collects and transmits sound to the middle ear. Middle ear The tympanic mem brane separates the external and middle ear. The center, or umbo, is attached to the tip of the long process of the malleus on the other side of the tympanic membrane.The eustachian tube connects the middle ear with the nasopharynx, equalizing air pressure on either side of the tympanic membrane. The middle ear conducts sound vibrations to the inner ear. Inner ear The inner ear consists of closed, fluid-filled spaces within the temporal bone. It contains the bony labyrinth, which includes three connected structures: the vestibule, the semicircular canals, and the cochlea. The inner ear receives vibrations from the middle ear that stimulate nerve impulses. These impulses travel to the brain, and the cerebral cortex interprets the sound. Auditory ossicles  ¦ Stapes (stirrup)  ¦ Incus (anvil) Malleus (hammer) Semicircular canals Vestibule Cochlea Cochlear nerve Eustachian tube Tympanic membrane (eardrum) Helix Anthelix Lobule of auricle External acoustic meatus Assessment 31 Assess ment Eyes Snellen charts The Snellen alphabet chart and the Snellen E chart are used to test distance vision and measure visual acuity. Snellen alphabet chart Snellen E chart Age differences 20 20 In adults and children age 6 and older, normal vision is measured as 20/20. 20 50 For children age 3 and younger, normal vision is 20/50. 20 40 For children age 4, normal vision is 20/40. 20 30 For children age 5, normal vision is 20/30.To measure distance vision: Have the patient sit or stand 20 (6. 1 m) from the chart. Cover his left eye with an opaque object. Ask him to read the letters on one line of the chart and then to move downward to increasingly smaller lines until he can no longer discern all of the letters. Have him repeat the test covering his right eye. Have him read the smallest line he can read with both eyes uncovered to test his binocular vision. If the patient wears corrective lenses, have him repeat the test wearing them. Record the vision with and without correction. Distance vision Recording results Visual acuity is recorded as a fraction.The top number (20) is the distance between the patient and the chart. The bottom number is the lowest line on which the patient correctly identified the majority of the letters. The larger the bottom number, the poorer the patient’s vision. The Snellen E chart is used for young children and adults who can’t read. 32 Eyes and ears Test peripheral vision using confrontation. Confrontation can help identify such abnormalities as homonymous hemianopsia and bitemporal hemianopsia. Here’s how to test confrontation:  ¦ Sit or stand directly across from the patient and have him focus his gaze on your eyes.  ¦ Place your hands on either ide of the patient’s head at the level of his ears so that they’re about 2 apart.  ¦ Tell the patient to focus his gaze on you as you gradually bring your wiggling fingers into his visual field.  ¦ Instruct the patient to tell you as soon as he can see your wiggling fingers; he should see them at the same time you do.  ¦ Repeat the procedure while holding your hands at the superior and inferior positions. Rosenbaum card The Rosenbaum card is used to evaluate near-vision. This small, handheld card has a series of numbers, E’s, X’s, and O’s in graduated sizes. Visual acuity is indicated on the right side of the hart in either distance equivalents or Jaeger equivalents. To measure near-vision: Cover one of the patient’s eyes with an opaque object. Hold the Rosenbaum card 14 (35. 6 cm) from the eyes. Have the patient read the line with the smallest letters he can distinguish. Repeat the test with the other eye. If the patient wears corrective lenses, have him repeat the test while wearing them. Record the visual accommodation with and without corrective lenses. Near-vision Confrontation Does your patient wear glasses or contacts? Remember to test his vision with and without his corrective lens es. Assessment 33 Each upper eyelid hould cover the top quarter of the iris so the eyes look alike. Look for redness, edema, inflammation, or lesions on the lids. Eyelids The corneas should be clear and without lesions and should appear convex. Examining the corneas Examine the corneas by shining a penlight first from both sides and then from straight ahead. Test corneal sensitivity by lightly touching the cornea with a wisp of cotton. The irises should appear flat and should be the same size, color, and shape. Irises Corneas Inspecting the eyes With the scalp line as the starting point, determine whether the eyes are in a normal position. They should be bout one-third of the way down the face and about one eye’s width apart from each other. Then assess the eyelids, corneas, conjunctivae, sclerae, irises, and pupils. 34 Eyes and ears Each pupil should be equal in size, round, and about one-fourth the size of the iris in normal room light. Testing the pupils Slightly darken th e room. Then test the pupils for direct response (reaction of the pupil you’re testing) and consensual response (reaction of the opposite pupil) by holding a penlight about 20 (51 cm) from the patient’s eyes, directing the light at the eye from the side. Next, test accommodation by placing your finger

A Study Of The Theme Of Profiling In Jenifer Thompson Cannino, Erin Torneo And Ronald Cottons Memoir Picking Cotton

A Study Of The Theme Of Profiling In Jenifer Thompson Cannino, Erin Torneo And Ronald Cotton's Memoir Picking Cotton As humans our minds tend to form thoughts based on different aspects towards people without having facts to back them up. It is purely a human tendency sometimes even uncontrollable. This is also known as profiling. Profiling can be based off many things, some for example are age, culture, gender, and race. Almost anything that can set one apart from another sets up the perfect stage for profiling. Profiling or any type of personal judgement in the mind is pure human performance, but said aloud or can cause much harm towards others. Profiling is extremely harmful outside the personal boundaries. Picking Cotton, is a great example of profiling. Its a meaningful story that shows profiling through different aspects. Though sometimes profiling others can simply lead to an argument or fight, this story leads to almost ruining someone’s life. Profiling has negative side effects for all involved, Picking Cotton clearly shows how profiling Ronald Cotton had a major impact on himself, his family, and even the women profiling him, Jennifer Thompson and Mary Reynolds. (As evident by the tragedy of Ronald Cotton’s story, it is imperative that society understands the harmful consequences of profiling a human being based on , to avoid wrongfully punishing or stereotyping innocent people.) (jennifer and ronald) (Cannino et. al 33). Profiling is simply a term defined as the recording and analysis of a person’s psychological and behavioral characteristics, sometimes this is done individually or by placing people in invisible groups. Picking Cotton is most definitely a novel written based off profiling. There is only one road that profiling can be used in good manners. That is purely using good judgement in your mind to profile certain people to test if they are either true friends or people you really want. When in situations where you meet new people and you have to make quick judgements on if they are safe to be around or spend time with; that is when profiling skills come into excellent use. Other than that path, profiling is extremely harmful to all who are involved. Media plays a major role influencing many young adults who take part in watching and listening to profile races and gender among other invisible categories. (because they should not be there in the first place) Growing up under two peopleà ¢â‚¬â„¢s influence for 18 years plays a huge part in the way you profile invisible groups. For example if you were to grow up under parents who were racists, that alone would hugely impact your view towards other races. Some homes force their children to believe what they themselves believe, while others let the children have the freedom to choose for themselves. Either way, the world you grow up in as a child leaves much residue on how your beliefs are formed as you start your adult life. Ronald Cotton was labeled as an African America male in his community due to his negative reputation he built himself growing up. Personally I have profiled others and I have been profiled. It is hurtful judgement that no one should ever have to deal with. Coming from an overseas perspective straight to an American perspective was a huge transition for me. I tried to be the â€Å"American† that I saw all around me, but inside I was the African I grew up as. Many people profiled me as a poor African girl. To make things worse, my parents are missionaries so that only added goody goody two shoes to my list. Yes, I did grow up in Africa and yes I am the daughter of missionaries, but that does not give you the right to profile me as a Christian, poor, African girl. I want people to look at the real me, not just automatically make assumptions due to invisible categories made. When I first moved back, I went in the direction of not telling anyone about where I was from or the family I grew u in, just to see what would happen. People tend to be more intrigued when I let them know where I am from. When they were blind to the fact that I am from Africa they were not as easily intrigued with befriending me, once their eyes were opened they automatically clung to me. It was almost sad to realize that being from Africa helped with the amount of friends I had. When people put me in the goody two shoes category I turned to a rebellion stage just to prove I would not be what they categorized me as. Once they categorized me as a wild child, I again turned back to the goody two shoes. People also profiled me as poor, due to the fact that I attended a name brand school, but instead I wore used or passed down clothing. When I was labeled poor, I automatically jumped to wanting to be the opposite. Realizing that I did not come from a rich enough family to afford name brand I switched to finding used name brand clothing. I was all over the place when I moved here back in 7th grade. Thankfully with those experiences this time around I am a much more grounded and independent person.

Economic Indicator Forecast Essay Example | Topics and Well Written Essays - 500 words

Economic Indicator Forecast - Essay Example State of Oregon projects that GDP will fall by 2.6% a rate that is not alarming in the short run given the resilience the economy has shown. Unemployment rate: Projections for unemployment (% of the labor force) are that the rate will be 5.2%. This is higher than the 4.7 % given by the Office of economic analysis (State of Oregon). The forecast is based on the fact that productivity growth rate has remained weak since 2004 GDP Deflator. IMF projects the figures for this indicator to be 2.0%. This is same as the figure given by the office of economic analysis Current account balance (% of GDP) IMF says that current account balance will decrease by 6.1% while the Office of economic analysis (State of Oregon) give their forecast as 5.0% this is attributed to the performance of the import market that will be adversely affected by the upward moving interest rates. Oil prices. Due to geopolitical factors namely volatility in the Middle East, and increasing demand especially in emerging mar kets, oil prices are set to remain high with both IMF and office of economic analysis agreeing on their projections that prices for the next quarter will be in the upward of $54 per barrel. Consumer price index (CPI). According to IMF, CPI will be 2.4% while the Office of economic analysis (State of Oregon) projects a 2.6% change. The rising cost of energy is among the factors that will influence this trend

Economic Crisis of 2008 and Natural Resources Essay

Economic Crisis of 2008 and Natural Resources - Essay Example However, the most notorious measures have been witnessed in the more indirect causes of natural resource depletion in poor legislation invented by the government and leading policy creators. These have affected the market trends to cause effects on the trends in trade and monetary values. These present a significant effect on the depletion of the available resources to accord the problem witnessed in other economic presentations in the factors to accord sustainability to the individuals. The factors to lead to the presented features that predict the fluctuating environmental sustenance have been projected, to the creations developed by humanity in the attempt to adjust to the harsh presentations of the natural environment. In times of societal challenges, the adjustments made have been included in the attempt to present counter measures that present sustainable measures to support humanity within the society. The famous economic crisis in 2008 presented the period of instability with in the economy with constrained opportunities, and global price fluctuations to increase overdependence on available resources that had been affected. The effects of the economic crisis of 2008 had been felt within households, and leading companies that provided support to the economy and the natural reserve hence the immense degradation of nature had been realized. Economic crisis of 2008 The period had been associated with the era that had presented the duration when the US and the global economy faced the problem in a remarkable financial crisis (Botchway 250). The evidenced had been extended to the failure of the failure of leading financial institutions to fail to gain the counter measure to generate the incentive to promote the development. Moreover, the period had been extended to the failure of the stock market to find the solution to counter the economic situation that had threatened to sustain the crisis. The witnessed effects had been projected in financial institutions t hat had been incapable of delivering the results in presenting a sustainable economy. In the period, the resources had been valued at a high price index with the increase in the oil prices that led to overdependence on alternative fuel sources. The solution had been to involve the use of affordable energy measures that led to an increased number in exploitation of natural reserve, to feed the population and economies that presented a challenge during the crisis. The crisis and natural resource The lack of funds meant that the maintenance of the available features had been reduced with the concentration on alternative measures to deliver satisfaction of the scarce resources. The management of the available resources is provided alternative measures to offer sustainability within the economies. Before the crisis, the countries with abundant resources included measures that would be directed to sustain and maintain the available facilities. There had been the provision to enact strict codes in the preservation of development features with harsh consequences to the perpetrators. However, the crisis led to the trend established that directed the effort to finding alternative measures to present financial balance and economic sustenance. The solutions had been grave to the economy and environment that presented the alternative to the available resource. The available funds had been diverted to projects that could sustain the economy with the focus diverted

Viewing Art Essay Example | Topics and Well Written Essays - 1000 words

Viewing Art - Essay Example The majority of the art produced by Soviet artists was created to support the ideals of the government and make their communism present in every part of the culture, especially the visual arts. Soviet art of the period consisted of pictures of workers farming, working in factories, or similar actions. In one way, it was good because they pictured women working alongside men which reinforced the idea of equality, but there is very little difference between the characters. They all look the same, which reinforces the Soviet idea that a person was only as valuable as their work to the state (â€Å"Into the 20th Century†). Examples of art used to oppress people are not limited to despotic foreign countries. Sometimes art can be used to reinforce social customs that are discriminatory or racist. The American film Birth of a Nation has been credited with justifying racism and discrimination against African Americans in the America south. The movie tells a fictional account of the fo unding of the Ku Klux Klan and how it was started to protect good white southerners against the black Union soldiers after the American Civil War. Birth of a Nation expressed a mythology about the southern United States and its identity that was not true and justified the use of violence and mistreatment of African Americans. In fact, the movie has been credited with reviving the Ku Klux Klan, which by then had already become inactive (Armstrong). Visual art was also used before the American Civil War to promote an idea of how the south was and to cover up the cruelty of slavery. Many landscape paintings of southern plantations did not picture slaves, instead focusing on the beautiful buildings and crops of the owners. Other landscape artists did paint African slaves into their pictures, but sometimes pictured them working happily alongside white workers. These representations perpetuated an idea of the American south as a peaceful, prosperous part of a country, whose slave owners w ere kind and whose slaves were happy (Mack). With all the time that people spend looking at art and interacting with it, we do not step back enough to wonder about what a piece of art or a piece of graphic design is saying to us. Most of the time, we simply respond. A good deal of art created in modern society is designed to get people to do things: to click on a banner, to buy something, to inspire feelings of patriotism or anger. Advertisers depend on the fact that the viewing public will not really step back and evaluate how an advertisement is trying to manipulate them and that they will just respond and click, or buy something, or vote a certain way. Claude Monet’s painting â€Å"Regate a Argenteuil† is a masterpiece that communicates more than the simple coercive ideas behind Soviet art and art in advertising. Monet’s impressionism was about replicating the experience of seeing something commonplace, rather than the realistic reproduction of grand and hero ic or mythological events as was popular in the 19th century. This painting, in particular, is not a realistic rendering of sailboats on the river Seine. The We Museum website calls it a â€Å"bold simplification† in which Monet was trying to capture the mood of boots sailing on a beautiful day (Pioch). Monet attempted, in this painting, to communicate that mood and his understanding that

Trucks Load Indicator also known by Electronic load indicator or Axle Research Paper

Trucks Load Indicator also known by Electronic load indicator or Axle load Indicator - Research Paper Example In addition, it is for this reason that several truck companies like Volvo, have embraced the use of axle load indicators in the trucks manufactured by their companies. Those who have been exposed to trucks will attest to the fact that they have axles. The number of the axles, however, varies depending on the truck with some of them having two axles whereas some have close to twelve axles. Overtime various stakeholders realized that there were several instances where the axles installed within the trucks were overloaded, and this always acted as a disadvantage for the truck (Butcher, 2005). To control the problem of weights, the stakeholders, came up with the axle load indicator and since then the original version has been altered with the aim of improving it. It is to this effect that several companies that produce axle load indicators like Airtec Corporation produce axle load indicators with optic switches. Some of the companies also produce axle load indicators, which contain rheostats instead of the normal electric switches. History, however, does not mention the exact individual who came up with the axle load indicator. Therefore, there is the need to appreciate the person because his invention has made handling the trailers much simple. For the axle load indicator to be operational, it has to be installed. It is far reaching to recognize the fact that the production companies have designed the axle load indicators in such a way that any able operator can do the installation (ARO, 2011). For surety reasons, however, there are dealers who deal specifically with the installation of the axle load indicators. The companies that do the production can as well avail their engineers to do the installation though at a cost. The installation, however, can be done through connecting the axle load indicator to the light circuit of the truck. Operationally, the truckload indicator registers some calibrations

WLAN Throughput Performance Research Paper Example | Topics and Well Written Essays - 1250 words

WLAN Throughput Performance - Research Paper Example   When there are multiple simultaneously active users transmitting data on the WLAN radio channel, the throughput decreases. This is because the users experience a collision. These colliding parties must wait for a defined back off period before retransmitting. This results in loss of air time thus affecting the system’s throughput.†¢ InterferenceRadio based WLAN are unregulated. Other products transmitting energy in the same frequency spectrum results in interference. For instance, microwave ovens can be a source of interference to a WLAN system. Most WLAN manufacturers design their products to account for this interference. Interference mostly arises from other access points (AP) on the same and adjacent radio channels. It can be mutual and harmful. In minimizing interference, different radio channels are used. Frequency hopping and other frequency optimization techniques are developing to help manage interference.†¢ Interoperability of wireless devices  WLAN s ystems from different vendors may not be interoperable. This is because different technologies will not interoperate. For instance, a system based on spread spectrum frequency hopping technology will not communicate with another system based on spread spectrum direct sequence technology. Moreover, systems using direct frequency bands will not interoperate even if they employ the same technology. In addition to that, systems from different vendors may not interoperate even if they both employ the same technology.

Ethical Behaviors in an Academic Field Research Paper

Ethical Behaviors in an Academic Field - Research Paper Example The research paper "Ethical Behaviors in an Academic Field" discusses the ethical behaviors in an academic field and the problem of plagiarism which refers to the approach or act of copying and taking the works of someone else and then using such work as if they belonged to the person who has copied them. It includes integrating the thoughts, ideas, and opinions of another scholar or scholar and then passing or including such ideas, thoughts and opinions into the works of one without giving any recognition or appreciation to them. In the academic, scholarly and research cycles, it happens when the author or a person copies information from books of the internet word by word with the intention or aim of pretending that one was the owner and original author or initiator of such. In some other instance, people paraphrase, rewrite, take words or summarize the ideas and thoughts of other scholars and thinkers without recognizing or appreciating the source of the information. This would be acceptable avoided by factoring in internal or in text citation where the person quotes the ideas and thoughts of another person but then acknowledges the author by mentioning their names immediately after such words or quotes. Self-plagiarism is the notion where a student uses his or her previous works for future or subsequent assignments. This is so when a student or a person tries to use his or her previous thoughts and ideas or opinion so as to answer questions or do research in future assignments and academic works.

Direct Marketing Essay Example | Topics and Well Written Essays - 2500 words

Direct Marketing - Essay Example Segmentation allows Sports Gear Incorporated to divide up its market into customer groups or segments. Customers within a segment are similar to each other and dissimilar to other groups of customers in other segments (Evans, et al. 2004). Segmentation will be used to understand individual customers in the sports memorabilia market place and to group them together to form distinct segments which are identifiable, accessible and substantial. At its simplest, a consumer segmentation may be: In business markets, segmentation is often used to make selling more cost effective by prioritising the companies that require regular face-to-face salespeople and that can be served better by telesales and direct distribution. Market segmentation involves finding out the key drivers that distinguish one group of customers from another. The key drivers of consumer market segmentation in sports memorabilia will be: Statistical modelling techniques can be used to isolate the key drivers and to identify customer clusters or groups. Alternatively, Sports Gear Incorporated can use off-the-shelf segmentation classification systems. There are two types of data: primary and secondary data collection. Methods of primary data collection can be thought of as the means by which information is obtained from the selected subjects of an investigation (Robertson, 1992). A sampling technique will dictate which method is used and in other cases there will be a choice, depending on how much time and manpower (and inevitably money) is available. The following methods can be used by Sports Gear Incorporated in order to collect primary data: Individual interview of sport club members and fans. This method is probably the most expensive, but has the advantage of completeness and accuracy. Normally questionnaires will be used. Street (informal) interview. This method of data collection is normally used in conjunction with quota sampling, where the interviewer is often just one of a team. Some factors involved are: possible differences in interviewer approach to the respondents and the way replies are recorded, non-response is not a problem normally, since refusals are ignored and another subject selected; convenient and cheap. Telephone interview. This method is sometimes used in conjunction with a systematic sample (from the telephone book). It would generally be used within a local area and is often connected with selling a product like sports memorabilia. It has an in-built bias if private homes are being telephoned (rather than businesses), since only those people with phones can be contacted and interviewed. It can cause aggravation and the interviewer needs to be very skilled (Dillman et al. 1996). Secondary data are generally used when: the time, manpower and resources necessary for its own survey are not available (and, of course, the relevant secondary data exists in a usable form), or it already exists and provides most, if not all, of the information required (Berry 1998). The

The End of the War is Just the Beginning Essay Example for Free

The End of the War is Just the Beginning Essay In the world of poetry, the most inspirational topics are often the most tragic. War is one of those subjects that evoke a bottomless well of stories, opinions, and emotions. Leningrad Cemetery, Winter of 1941 and Dulce et Decorum Est are two examples of poems centered around battle with different perspectives on war itself. In the poem Leningrad Cemetery, Winter of 1941, author Sharon Olds gives an account of a visit to a burial site where hundreds of dead bodies lay, victims of the siege on the city of Leningrad in World War II. The image is further darkened by the fact that since the ground is frozen, the corpses are unable to be buried. The overall effect created by this poem is to show the brutality of that time on and off the battlefield, as well as to convey the message that there is no hiding from the truth: the world is not a perfect place. The use of metaphors and similes, diction, sounds of words, and most importantly, the overall tone communicates harsh details. Though distributed throughout the work, these features are sometimes concentrated in specific sections; my guess is to create a stronger effect en masse. Though written without stanzas, I could see this poem being divided into four separate parts. The first part serves as an objective view of the cemetery itself and describing the image before the speaker. The first line That winter, the dead could not be buried (1) creates the sort of impact that Olds wanted to have carried throughout the whole poem. This unflinching depiction of truly gruesome scenes is what makes this piece so powerful. Readers are given an image of bodies lying in the cold and then told that the coffins were burned for firewood and that the gravediggers too hungry to work. This is, to say the least, a very bleak picture. When I read the next section, the s sounds filled me with a bit of a chill like I could feel the cold of the winter there. So they were covered with something and taken on a childs sled to the cemetery in the sub-zero air. (5) This is an example of one of the many tactics used by the author to further draw the reader in and make the poem more of an involving experience and not just some words on a page. The next defining section comes with the description of the corpses themselves, though not in a the same grisly detail-filled way as would be suspected after what had been written so far. Although the overall descriptions are tragic, they are camouflaged by metaphors and similes dealing with positive messages in an attempt to pull away from this grim spectacle. Corpses wrapped with dark cloth and rope are compared to a trees ball of roots/ when it wants to planted(8) an image often associated with the beginning of somethings life, not the end. The same lifelike comparison is found in the next sentence when those wrapped with sheets are associated with cocoons that will split down the center/ when the new life inside is prepared (11). Another very positive outlook on the current situation, but also very out of place, especially considering the diction used later to describe the corpses as, pale, gauze, tapered shapes/stiff (10). However, the work then takes a complete turnaround and changes positions very quickly, taking the antithesis of the previous comparisons by associating the bodies with inanimate objects naked calves/ hard as corded wood(14). Its as if the speaker is returning back to the reality of the present situation from the temporary escape the speaker had just made with his positive descriptions and allusions to new life. The use of sounds of words is used once again, but with a sharp k sound to emphasize the harshness of the surroundings. But most lay like corpses, their coverings coming undone, naked calves hard as corded wood spilling from under a cloak, a hand reaching out (15) This harsh alliteration gets back to and more closely follows one of the original motivations of the poem, to shock and disturb readers. The last part of this poem, without a doubt, holds its most powerful image and in turn its most powerful message serving as the best example of the pieces straight forward and introspective tone. From under a cloak, a hand reaching out with no sign of peace, wanting to come back even to the bread made of glue and sawdust, even to the icy winter, and the siege. (18) Throughout this work, there are a number of references to death and life, ends and beginnings, but this is the only mentioning of a longing to return to life from death. It strongly communicates the idea that any sort of life that the reader is leading, no matter how bad, is a life nonetheless for which he or she should be grateful. Here these corpses lay and would give anything to be alive, even if it meant living in this awful place under these terrible conditions. Its better than death. The use of general and formal features explains both the speakers attitude towards the scene at the cemetery as well as creates a stance on Grays theories concerning the lust of the eye. The two practically overlap because the goal of the work is to recreate the scene that caught the speakers eye in the first place. Then relay it to the audience and capture them with the lust of the poetic ear. Shock and amazement are prevalent throughout this piece, especially in the end and the sight of the outstretched hand. Though different from Grays panoramic and impersonal images of power and destruction, these grisly images evoke the same lust of the eye in the speaker and upon viewing them, he tries to delude himself. By comparing the images he sees to more positive visions he can relate to, such as the butterfly cocoon and the trees roots, he feels more comfortable, it calms him. These ideas are but fleeting, though, and he is brought back to realize that the world is no longer perfect. It is as he sees it and no more, and that is overall message. There is no escape from the truth. In the poem Dulce et Decorum Est, author Wilfred Owen provides the reader with not just one, but two entirely different views on war, both of which vary greatly from Olds. Written in an as it happens type style, the piece depicts a group of soldiers caught in the middle of a mustard gas attack during World War I. Owen then switches gears and describes the aftermath of the assault with a cynical view not apparent in the first half of the poem. The purpose and overall effect of this poem is tell the reader that the messages created by the media are wrong and that dying for ones country is not a glorious thing. This idea cant be truly realized unless one has looked death in the face personally. The use of tone, imagery, diction, and stanzas are crucial in getting this point across and I have pointed out where and how they are utilized. The first thing that struck me about this poem was the impact created by the imagery used by the author. Like the Leningrad cemetery, this view it is powerful in scope; only filled more with action and allows less time for reflection by the reader. The first scene is described as a group of soldiers returning from battle Bent double, like old beggars under sacks,/ Knock-kneed, coughing like hags, we cursed through the sludge, (2) Moving as this image is, it is somewhat ironic that the imagery can be so powerful when you consider that due to the gas, the senses of the speaker and his companions are practically inoperable. This somehow enhances what the reader experiences. I say this because if these soldiers could take everything in, it wouldnt be any great surprise for them because they were so desensitized to war, a familiar concept felt in Olds poem. I often viewed the speaker in the Leningrad cemetery as being someone like a reporter or gravedigger that no longer sees the bodies as the truly lay. He can only see the images that the bodies remind him of. However, by describing normally insignificant events of battle going on around those numbed physically and mentally, the audience is given a clearer picture of what the world they are living in is like. Drunk with fatigue; deaf even to the hoots/ Of disappointing shells that fell behind (8). Bombs fall around them and they pay no heed. This ignorance lasts not for long though. Gas! Gas! Quick, boys! An ecstasy of fumbling/ Fitting the clumsy helmets just in time (10). This surprising interjection of action breaks the ambience of the background noise and the silent solace in which they marched. Inventive and unorthodox diction is responsible for making some of the most profound statements in this section that much more noticeable. Not only for the scenes these words help to create, but to make the reader stop and question their usage. The use of the word ecstasy to describe the fumbling of the gas mask caught my eye. Whether we should view this as comical or just plain hopeless leaves the audience uncertain what to feel and in a way temporarily pulls the reader away from the seriousness of the current situation. But someone still was yelling out and stumbling/ And floundering like a man in fire or lime (12). Gripped with a fear for his own life and the gravity of the moment, the speaker can do nothing but watch his comrade guttering, choking, drowning (16). Another example of how the power of the diction fuels the fire of the emotions already being felt by the reader. Its after this point that the speaker reaches his breaking point and realizes that things will never be the same. The stanzas, which had been similar in length and mostly objective, take a dramatic turn in the last half of the poem. After watching his companion die, a new stanza starts only two lines in length. As in the first poem, the last part of the work takes a turn to make an overriding point with just one image. In these sentences, the speaker stops reflecting on the past and talks about the present. In all my dreams, before my helpless sight/ He plunges at me, guttering, choking, drowning (16). We realize that for the speaker, this war has never really ended for him, but just keeps getting replayed over and over in his head. He knows hell never be able to shake that image and expresses his feelings in the final stanza. In this last and most important paragraph, time slows down and the memory burned into the speakers head comes bubbling to the surface, as fresh as if he had seen it yesterday. He accounts, with gruesome details, the body of a dying soldier flung in the back of a cart. A man whose slow death he had been witnessing for the past few minutes and was unable to help. He was now on his way to being just another statistic and the all the speaker could do was watch. And watch the white eyes writhing in his face/ His hanging face, like a devils sick of sin; (20). It is here that his tone becomes obvious and he relays to readers his belief about war and that the glory so often talked about is absent when it comes to dying on the battlefield. As General Patton once said, No man ever died for his country. Go out and make some other man die for his country. Both of these poems strongly emphasize the aftermath of war more than the grand spectacle itself. Its this shared factor that in a way negates what Gray says about the lust of the eye and becoming separated from the world by the panoramic and jaw dropping sight of battle. Though neither of the poems disproves this idea, both Olds and Owen focus on a different lust of the eye, one having more to do with what is seen at the end and not so much during the conflict itself. The images of the dead create a lasting impression in the readers minds that as uncomfortable as it may be, must be a thousand times worse for a material witness. It gives me a whole new respect for veterans. I no longer appreciate just what they did, but what they have to live with.

Ford Modular engine Essay Example for Free

Ford Modular engine Essay †¢Come up with six follow-up questions that you could ask to help further your investigation and support or disprove each hypothesis. †¢According to an anonymous town resident, the spike in absences coincided with the annual anniversary of the death of the town’s founder, Jeremiah Potts. The founder died 150 years ago during the month of May following an unexplained illness, and ever since his death, he haunts the public buildings causing symptoms similar to the illness that he succumbed to. †¢Provide an explanation for why the hypothesis of the anonymous resident is not an acceptable one for an investigation based in science. Include in your explanation a comparison of this hypothesis to the two that you created based upon the available evidence. Submitting Your Assignment Save your copy of the assignment in a location and with a name that you will remember. Be sure to use the Save As option to include your first and last name in the title of the document. For example, your assignment might be called Shawn_Edwards_Assignment2.doc When you are ready to submit it, click on the Dropbox and complete the steps below: †¢Click the link that says Submit an Assignment. †¢In the Submit to Basket menu, select Unit 2: Assignment †¢In the Comments field, include at least the title of your paper. †¢Click the Add Attachments button. †¢Follow the steps listed to attach your Word document. †¢To view your graded work, come back to the Dropbox or go to the Gradebook after your instructor has evaluated it. Click the Dropbox to access it. ID: SC300-02-09-A Data reported as percentage of students absent

Handling Teenage Pregnancy Analysis Social Work Essay

Handling Teenage Pregnancy Analysis Social Work Essay Teenage pregnancy is no longer a surprising news to the public. Teenage pregnancy referring to McGraw-Hill dictionary, understood to occur in an age 13 to 19 who has not completed her secondary school study, has few or no marketable skills, is financially dependent upon her parents or continues to live at home and is often mentally immature . It made a critical impact upon Hong Kong society and it became a significan issue in society and academic fields. The paper would illustrate the brief history and contemporary situation in Hong Kong. It will also analyzes the social work pratice area of teenage pregnancy in Hong Kong and the reason why it is a hard task to deal. This is one of the social work practice that I think it is difficult for me to work on. I would review literature and cases about how can social workers handle this problem for the preparation for the further study and future work. Introduction In the past ten years of the 20th century, British governments became aware of teenage pregnancy issue as a significant public health and social problem . As a long-time sociologist on this isssue has observed, teenage pregnancy has become a veritable industry . This view was shared by Hong Kong society. Official statistics have already clearly shown the teenage pregnancy problem years ago. According to the a public survey on school-based sex education in Hong Kong conducted by Department of Social Work at The Chinese University of Hong Kong, among those aged 26 or below who requested for abortion in the past three years, 3% of them were teenagers below 16. Moreover , 183 teenagers aged below 18 gave birth in 2006 . All these statistics have again aroused the public concern. For the social work field, this is a social issue worthy of discussion. A local youth organization in Hong Kong conducted an exploratory and qualitative study focusing on teenagers who had become pregnant under the age of 18 (Hong Kong Federation of Youth Group 1995b). This is a in-depth study on teenage pregnancy in Hong Kong. The total of 25 girls were interviewed whom were referred by the Social Welfare Departmaent and other NGO. The study aimed at finding out their attitudes towards sex and contraception as well as the decision-making process regarding abortion. It explored that more interviewees chose to have an abortion in Hong Kong than to give birth to a baby that may trouble their futures. About half them made the decision to terminate the pregnancy within 2 weeks. However, four girls could not make up their minds or come to an agreement with their boyfriends . In these cases, the 24th week passed without a decision, making it too late for a legal abortion. Dealing with their issues of pregnancies, they worried more about the unpredictable chang es in their future life than the social moral or others impression on them. All in all, it concluded that these girls had actively participated in the decision-making process, moreover, even make the decision by themselves. In some condition,heir parents were not in direct practical help and some parents even did not know the problem at all. Difficulties in handling teenage pregnancy I know the most difficult part for me to handle the teenage pregnancy case is client self-determination phase. The client may be already suffered from her own confusion and the complicated emotion. As a professional social worker, must help the client to understand the pros and cons in her situation. Following the NASW Code of Ethics social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals . This decision making is an overwhelmed task for everyone. To choose an abortion, means a loss of a essential attachment relationship . It is a more psychological tramua than a biological hurt. Choosing to keep the baby, also lead to a loss of the normal life, facing the threat of social norms, financial problem, parental style, end up of education, etc. It seems that there is never a good choice. In this helping process, it may conflict with my own interest and personal value and I afraid that would influence the clients self-determination ability. I feel confident with my professional of non-judgmental, but talking about providing the options, it is hard for my preference of anti-abortion. My mother is a Christian and her Christian value of opposing abortion has a great affect on me. From a Christian view, deliberate abortion, unless the mothers life is in danger, is murder. I agree with the idea that this is kind of killing the most defenseless livin beings by taking away their most basic right to live, without their permission. So this is also the reason why in some countries, abortion is illegal. The baby is innocent. It is a tragedy that one have no right to determine to live or not. I regard the baby as human life though some people say it is only an unwanted tissue. Besides, teenage abortion patients are more likely to come up with physical risks. Because their bodies are not yet fully developed and can not produce pathogens, which are found in the cervical mucus of older women and protect them from infection . These teenagers are also twice as likely to experience cervical lacerations and higher risk for post-abortion infections such as pelvic inflammatory disea se and endometritis . Scared by above information, I was clear that my personal interest is an obstacle to me of giving the unwed mother the choice of abortion. On the other hand, continue the pregnancy, the major concern is raising up the baby. If the baby could not born in a complete family, or the parent were reluctant to accept his/her, it may cause a negative effect on the babys whole life. It is not his choice to come to this world, but he have to bear all these. I really believe in the family of origins lifelong affect on the baby. Social scientists have found that the children growing up in single parent families are disadvantaged in many aspects comparing to a two-biological-parent families . Studies shows that these children are more potentially to have deviant behaviors such as become low acadamic achievement, drug abuse, join a gang, ect. Many of these problems are related to the poor economic condition and parenting style. To be honest, none of us want to born in a single parent family. The child may rather his mother did not give birth to him, but he have no choice. I worry that my dilemma of these cases would affect these sensitive teenage as they are really vulnerable under such condition. In the future work, I realize there is no way to escape from all this kind of issue. I have no choice but find out a applicable way to deal with it. How do social worker handle teenage pregnancy After doing literature review, I found the cardinal values of social work give me an effective support to handle these crisis. The Code of Ethics point out that all human beings deserve access to the resources they need to deal with lifes problems and to develop their full potential . As a social worker, we must believe that the client have the ability to make the preferable decision. Keep neutral and enhance their problem-solving and decision-making capacity in order to avoid conflict between our personal beliefs with the clients value. Tough decision to make Applying empathy to this kind of cases, we should recognize their emotional reactions. If we can not stand in their positions, it is impossible to help them to help themselves. During this period, their emotion would be easily affected and would go through shocked, frightened, frustrated, angry, helpless, lost and alone, worried and shameful. Showing acceptance and being supportive is essential, it can lower the clients anxiety and build up a trustful relationship. After the clients management of her emotion, weigh out the options, for example: her mental or physical health during prenancy, the financial conditionl and family support of the teenagers family, the family and status of the father, the future education or other plans for her . In the helping process, she is assisted to appraise her strengths and weaknesses as well as her extant resources and limitations, identify and assess alternatives, show empathy on her thoughts and feelings as well as take serious consideration of the welfare of the baby . Understand and inform the client about the pros and cons of all the choices, utilize the resources and then respect her choice no matter what it is.. Though the final decision is made by the client, this choice in fact would not be decided by her own. No doubt this would involved of her family support system or partner and friends social network. These teenager are tend to make decision under the pressure given by their parens or boyfriends. Mothers choice Usually, social worker whom work on the teenage pregnancy case will provide the teen three options and help this client to assess her situation. Keep the baby. If the client decide to keep the baby, the social worker should make it clear to the realistic demands of the costs whether now or the future. Make sure she get the fully perspective of the future challenges. Many kinds of responsibilities she has to take, such as physical and psychological changes, financial risks or maternal management. And the most important, is she well prepare for the new role of a parent. Give the baby up for adoption. The most crucial task before the babys birth, is consider to make the maximum benefits for the baby. Though it may broken the mothers heart. After concerns of the babys better future, some pregnant girls will continue their pregnancies and painfully give up the baby for adoption. If the client face her situation of not ready for a parenthood, no matter what kind of factors, we should respect her choice. She is bravely admitting she is not ready to becom a mother but want her baby to achieve a better life. To choose adoption can arouse the sense of loss and guilty. This feeling will start with the pregnancy itself because the expectant parents realize the fact of accept the loss of their own immediate life plans . Dealing with sadness and guilt is not easy, some of them may really suffer from the fact that permanently separated from their child or even feel grief and shame last a lifetime. So analyze all these cost and possibilities and inform her as much details as possible, it help her feel in control and confirm of making this decision. End the pregnancy. Some time abortion is a hard but reasonable choice. Abortion is a very sensitive issue for many people and a very difficult decision to make for many women. But to some extent, finacial or psychological limitation, they have no choice but to give up their babies for adortion for further consideration. Having an abortion under 24 weeks is considered legal in Hong Kong. Also, social worker should make sure that the client is informed the possible consequences, by consulting the doctor, the family and the partner to evaluate the determination. How if I face this issue As I realize the difficulties of myself in dealing with teenage pregnancy, the best way to solve this dilemma is follow the ethical principles. All social workers work is helping people to help themselves. What I have to do is to help her find out the best way to solve her problem. First is to keep confidential. Only in this way, the client assured that their information will not known by others so that will talk freely and provide more imformation. The principle also point our the confidentiality is not absolute when the client present a danger to self or others . I may discuss this concerns with my client and let her to decide whether to continue the services under such situation. A teen may face a dilemma, whether to tell others or not. When we feel the involvement of a parent or friends could be helpful, but she may not want any outside involvement . It is reasonable that under the pressure of social norms, this young girl will like to keep a secret. Senior social work suggest that the best way is explore her reluctance of telling others, after that, is up to her decision. And then, consent is an important ethical issue as well. We suggest voluntary involvement with the case to the client. For instance, Canadas common law states that people can consent if they are capable of understanding their problem, the proposed treatment, and the likely consequences of having or refusing treatment . In another word, it is her choice to consent or refuse. Facing any kind of deviant behaviour, a social worker must be non-judgmental. All of us were have been taught that we should not make judgments in class. As a human being, it is hard of putting none emotion on others. Geldard holds the view, that being non-judgmental and treating client with unconditional positive regard are goals which we should try our best to achieve. Though this is difficult, we need to explore in supervision any personal issues which may be interfering with their ability to be more accepting . I should strive to do this in order to build up a trustful relationship with the client. Conclusion Teenage pregnancy is a multifaceted issue that involve so many factors. As a social worker, understanding these teenagers as they try hard on making their decisions regarding sexuality and parenthood involves , keep in touch with their perceptions of themselves and their assessments of the opportunities that waiting them . After writing this paper, I recognize I had considered too much about humanitarianism and fostering a healthy baby, but neglect the pregnant teenager-my client. A social workers most concern is how to help the client to make maximum benefit in her situation but not to judge if they are right or wrong. I have to learn and practice more on believing in the clients ability to solve the problem and respect her choice. I will not pass judgment on the client who are confronting difficult decisions, they are doing the best they can.