Case Study And A Oncology Health Assessment

Case Study And A Oncology Health Assessment This case study concerns a patient, Mrs. Singh who is diagnosed with stomach cancer and is being managed with chemotherapy. Mrs. Singh, a 78yr. old female, presents to the oncology center with the chief complaint of feeling weak and hugging the wall while walking. Mrs. Singh is a known diabetic, and was accompanied by her daughter to the clinic. A thorough focused health history accompanied by a focused physical examination was done to ascertain possible nursing diagnosis related to Mrs. Singhs presenting complaints, current diagnosis, and treatment used presently. Health History Using COLDSPA, this information obtained will allow for a focused health history of the presenting problem. (Weber Kelly 2007) Patients vital signs will be assessed temperature, pulse, blood pressure, respiration and oxygen saturation. Blood pressure in lying, sitting and standing will be assessed. If needed, (any nasal flaring, use of accessory muscle of respiration or difficulty breathing) oxygen via nasal cannula will be administered. The character of the weakness The onset when did the weakness begin, is it better or worse since it began? Location where exactly is the weakness, does it spread to other parts of the body? Duration how long does the weakness last, does it recur? Severity how bad is it on a scale of 1-10? Pattern what makes it better, what makes it worse? Associated factors what other symptoms accompany the weakness, is it possible to do work or engage in other activities such as leisure/exercise during this? (Weber Kelly 2007) A biographical data is part of the health history, and would be obtained prior to entering the center (see Appendix). However, key features that the nurse takes into account will be discussed. Weakness can be caused by a variety of medical conditions, such as: dehydration, stroke, myasthenia gravis (or other autoimmune disorders), electrolyte disturbances, anemia and infections. The obtaining of a current medical history and family history is vital in order to link other possible complications involved. (McGraw Hill Medical 2010) Assessment will be directed towards: neurological (combining musculoskeletal and peripheral), cardiovascular, and gastrointestinal systems (including nutritional). (Merck Manual 2010) Health History Mrs. Singhs chief complaint is a history of weakness, being unable to walk without hugging the wall. This weakness, according to Merck Manual (2010), may be due to the disease process of stomach cancer, diabetes mellitus as well as from the chemotherapy that she is presently having. Mrs. Singhs age, is an indication that she is postmenopausal, (Manson 2008), which can also contribute to her being weak as well as the possibility of hormonal treatment she may be receiving. (National Institute of Aging 2010) An inability to stand for long periods of time due to weakness is also a presenting symptomatology of menopause, according to Mayo clinic (2010) Mrs. Singh is a diabetic; this can cause weakness, due to diabetic polyneuropathy. However knowing the type of diabetes Mrs. Singh has will also assist the nurse in verifying the drugs Mrs. Singh is presently taking. Hypoglycemia can also present as weakness. These symptoms can be also related to an overdose of insulin (if insulin dependent) or other hypoglycemic agents as well as not eating on time. Blood glucose monitoring via a Diascan would be done at this point in time. Renal involvement will also be assessed as this may be secondary to DM. Electrolyte blood values will be assessed (Merck Manual 2010) Mrs. Singh is diagnosed with stomach cancer. Time of diagnosis as well as the management for the stomach cancer will be taken as part of the health history. This is very important, as the patient with stomach cancer may have had different types of surgery done to treat this. Also the staging and grading of the cancer is important to verify the possible metastatic sites. Endoscopic mucosal resection, subtotal or total gastrectomy with or without lymph node removal may cause complications afterwards, such as abdominal pain, gastro esophageal reflux, weakness related to vitamin deficiencies and inabsorption. (American Cancer Society 2009) Another study showed postoperative complications for stomach cancer resulted in cardiovascular complications, hemorrhaging, septic shock, anastomotic leakage and abdominal and wound infections. (Japanese Journal of clinical oncology 2010) Dumping syndrome can also result in extreme weakness, which may result from surgery for stomach cancer. This occurs as there is a rapid movement of nutrients directly into the small intestine. (Merck Manual 2010) The type of chemotherapy that Mrs. Singh is presently having as well as her compliance to it is also taken as part of the history. Chemotherapy drugs used for stomach cancer are: Fluorouracil Doxorubicin, Epirubicin, Methotrexate, Etoposide, Cisplatin, Irinotecan, Paclitaxel, Docetaxel, Mitomycin C, Vinblastine, Cyclophosphamide, Cytarabine and Vincristine. Knowing the type of chemotherapy drug is relevant to assessing and monitoring possible side effects, even though most chemotherapy agents causes severe bone marrow depression leading to anemia. Methotrexate can lead to central neurotoxicity, Vincristine, peripheral neuropathy; together with Vincristine can cause serious weakness. (BC Cancer Drug Agency 2006) Cisplatin may lead to ototoxicity causing problems with balance, which Mrs. Singh may have as she is holding on to the wall to walk. Neurotoxicity is also caused by this drug, and may also contribute to severe weakness. Doxorubicin may cause cardiovascular abnormalities which may present as myocardial infarctions, causing weakness, an inability to stand and walk without assistance. This is treated as a medical emergency. Hence during cardiac assessment, a 12 lead ECG should be done to assess heart rhythm for pending supraventricular tachycardia, myocardial infarctions or other dysrhythmias. (BC Cancer Drug Agency 2006) Neurological assessment: level of consciousness, posture and body movement will be assessed. A score will then be obtained (G.C.S) in order to ascertain Mrs. Singhs neurologic status. Cranial nerve assessment will then be performed together with posture, all reflexes, mood, speech, facial expression and cognitive status. (Weber Kelly 2007) This will allow the nurse to ascertain whether the weakness is due to a neurological problem, as Mrs. Singh is a known diabetic. The use of the chemotherapeutic drugs can also affect her neurological status as well, hence the importance of this assessment. Observations for any stroke or history of same will be done. Drooping of face or any side of the body will be assessed for. Since Mrs. Singhs balance is affected, a thorough assessment for balance, using the Rombergs test would be done. (BC Cancer Drug Manual 2006) Gait and balance, together with strength of muscle and tone will be assessed. Nutritional assessment: Patient will be assessed for anorexia, dyspepsia, weight loss, abdominal pain, constipation, anemia, nausea and vomiting as these may all be related to the weakness she is experiencing. The daughter will be asked to answer as well as Mrs. Singh. (Weber Kelly 2007) Cardiovascular assessment Observation of the jugular veins for venous pulse and pressure would be done. Carotid arteries would be ascultated for bruits and palpated to determine the pulse. This can indicate hypovolemia, if the pulse is weak and may be associated with weakness. (Health Medicine 2010) The precordium will be inspected for any pulsations. Any heaves, lifts observed on the precordium, and abnormal pulsations palpated, may be an indication of an enlarged ventricle from an overload of work. This can be caused by chemotherapy agents such as doxorubicin (cardiotoxicity). Mrs. Singh being a diabetic as well could develop cardiac complications secondary to the diabetes. (Cecil 2002) Auscultation of heart rate, rhythm, heart sounds and extra heart sounds may be an indication of cardiac abnormalities such as aortic regurgitation. (Weber Kelly 2007) Nutritional status will be assessed, which will involve what is her daily intake: food and fluid, her weight will be assessed and compared to her baseline weight. Mrs. Singhs intake and output will be assessed in the last 24 hours with any supplements/ vitamins taken. For a vitamin deficiency can lead to peripheral neuropathy. Patients blood values as per laboratory chart will be assessed: hemoglobin levels, WBC count platelet levels for any abnormalities. Can pt. tolerate a full diet or what is the intake, what food can she eat or any changes in eating habits as well as presence of mucositis. Skin, hair and nails would also be assessed for dehydration. The patient will be asked if any bleeding was observed in stools. The nurse will assess occult blood in laboratory reports. (Weber Kelly 2007) Observation of body build, muscle mass and fat distribution will be taken in accordance to weight and height. (Body mass index). Assessment of Mrs. Singhs skin for turgor, moisture and venous filling will show fluid volume status. Observation of the neck veins will also identify fluid volume status. The tongue will be observed for hydration (furrows), as well as, the eyes position and coloration for signs of dehydration. Palpation of the eyeball will verify any dehydration. Auscultation of lung fields will identify any fluid present in the lung. (Weber Kelly 2007) Inspection of abdomen The abdomen will be observed for colour. A purple discoloration of the flanks will indicate bleeding within the abdominal wall. Abdomen will be inspected for jaundice (yellowing), paleness, swelling, hernias, abdominal movement, contour, symmetry, striae, vascularities, scars, lesions and rashes as well as, aortic palpations and peristaltic waves. Umbilicus will be inspected for colour, deviation from midline, contour. (Weber Kelly 2007) Auscultation of bowel sounds, vascular sounds and friction rubs over liver and spleen will be done. Absence of bowel sounds can ascertain any abdominal surgery being done or can be an emergency. Bruit over abdominal aorta, renal, femoral or iliac arteries may indicate an aneurysm. Friction rubs heard over liver or spleen may indicate metastases. (Weber Kelly 2007) Percussion of the abdomen is done for tone. Dullness over the liver or spleen may indicate hepatomegaly or splenomegaly. Measuring the span of liver and spleen will also allow the nurse to assess any decrease or increase in size from the normal. Light and deep palpation of the umbilicus, liver, aorta, spleen and kidneys would allow any masses to be verified which may be related to tumor growth or presence, aneurysms or metastases. Shifting dullness and fluid wave test will be done. (Weber Kelly 2007) Possible Nursing diagnoses Weakness related to diabetic polyneuropathy and side effects of chemotherapy (anemia) as evidenced by displayed weakness. Imbalance related to chemotherapy side effects as evidenced by pt. inability to stand. Nutritional imbalance: less than body requirements related to chemotherapy or G.I. surgery as evidenced by displayed weakness. Impaired physical mobility related to impaired balance as evidenced by Mrs. Singh hugging the wall to walk Powerlessness related to chemotherapy and inability to perform activities of daily living as evidenced by inability to maintain balance and walk (RN CENTRAL 2010) Conclusion A thorough health assessment of Mrs. Singh was done which included a focused health history as well as a focused physical assessment in order to formulate nursing diagnoses for appropriate nursing interventions and referrals to be made as immediate as possible. This allowed for the chief complaint to be logically analyzed for a plan of care to be developed for Mrs. Singh. A framework was provided (COLDSPA) as well as, scientific literature to validate all assumptions made.

Explore how Stevenson has presented the character of Mr. Hyde Essay

Comment on how the author has created a sense of evil in this character. â€Å"Dr. Jekyll and Mr. Hyde† by Robert Louis Stevenson is a novella written in the gothic style, first published in 1886. It is linked to other works written in the same period of time and in the same style, most notably â€Å"Dracula† and â€Å"The Picture of Dorian Gray†. During that period, it was believed that people had doppelgangers, or evil twins; this is how Victorians explained the duality of a person. Duality is a theme greatly explored in the novel; not only the duality of an individual but the duality of Victorian society as a whole. â€Å"Dr. Jekyll and Mr. Hyde† demonstrated the fact that many high class citizens, who appeared fine and upstanding, hid dark secrets, especially sexual ones: exactly like Henry Jekyll. Another theme explored in the novella is that of the importance of reputation and class. For example Utterson and Enfield try to avoid gossip and maintain their respectability. Similarly, Utterson tries to preserve Jekyll’s reputation, even though he senses something is not right. â€Å"Dr. Jekyll and Mr. Hyde† has an episodic narrative structure in the fact that it is divided into specific significant events. Mr. Utterson is portrayed as an investigator of sorts, looking for clues and attempting to solve the riddle behind his friend’s mysterious behavior. Furthermore, the truth is withheld until the end and finally revealed with the deaths of Lanyon and Jekyll in order to heighten the disbelief in his readers. Hyde’s first introduction to the readers is when he tramples over a young girl. This prejudices the readers’ impression of him because it depicts him committing an act of cruel violence. In addition, the language used to describe Hyde -specifically similes- adds to the already terrible impression the readers have of him. For example, he is depicted as being â€Å"like a juggernaut† and â€Å"carrying it off†¦like Satan†. This illustrates that he was like an unstoppable force of evil and frightens and alarms the reader. Victorians would be taken aback by this as they were very religious and believed in Satan. Both the doctor and Mr. Enfield experience â€Å"the desire to kill him† in response to the incident and this would stun readers as they wouldn’t expect such a dramatic reaction from what appear initially to be quite calm, rational people. Many characters are unnerved by Hyde but unable to give an exact description. However, most agr ee that there is something unnatural about his appearance: â€Å"not easy to describe†, â€Å"displeasing† and â€Å"downright detestable†. Stevenson has been deliberately vague about Hyde’s appearance, engaging the readers and allowing them to envision what Hyde looks like individually. As a result, Hyde will look evil to all readers, now and many years from now. In â€Å"Search for Mr. Hyde† Mr. Utterson is distressed at the news that Hyde, a complete stranger, is set to inherit Jekyll’s fortune in case of his â€Å"disappearance or unexplained absence†. This is a narrative hook Stevenson has used to entice his audience to delve further into the mystery. Additionally, Stevenson has built up trust and a sense of security in Mr. Utterson from the beginning of the novella: â€Å"somehow loveable† and â€Å"eminently human† leading the reader to trust his narrative and respect him. Contrastingly, Stevenson has used language to create a sense of evil in Hyde during Mr. Utterson and Hyde’s encounter. For instance: â€Å"Mr. Hyde shrank back with a hissing intake of the breath†, illustrating that he is primitive and almost animal-like. â€Å"That is my name. What do you want?† is Hyde’s reaction to Mr. Utterson addressing him, indicating that Hyde is extremely anti-social and isnâ€℠¢t used to communicating with human beings. After his encounter with Hyde he encourages readers to investigate Hyde: â€Å"there is something more†. This creates indistinctness and suspense. Moreover, Stevenson’s description of Hyde after his encounter with Mr. Utterson emphasizes the sense of evil created previously. Through the repetition of â€Å"deformed† and â€Å"deformity†, he generates a sense of wickedness as during the Victorian era deformity was viewed as something repulsive that should be locked away, hidden from the public eye. Furthermore, Utterson’s reactions to Hyde support this: â€Å"disgust, loathing and fear†. Here, Hyde is compared to Satan again: â€Å"Satan’s signature upon a face†. Victorians would be very shocked by the reference to Satan as to them Satan was the most powerful force of evil on Earth and his â€Å"signature upon a face† would make the person extremely wicked and malevolent. Next, the random act of violence in â€Å"The Carew Murder Case† greatly affects the readers’ opinion of Hyde. Stevenson has built up the feel of iniquity in Hyde through the maid’s description of the crime. The verbs and adverbs used are particularly effective. For example, the verbs â€Å"clubbed† and â€Å"brandished† develop a sense of cruelty in Hyde. What’s more, the aural imagery used allows the reader to visualize the crime, accenting it and Hyde’s brutality. The maid describes Hyde as behaving â€Å"like a madman† and having â€Å"ape-like fury†, which suggests Hyde may not have been in control of his actions and maybe even suffered from a mental health disorder. However, Victorian readers would not have interpreted that in this way, as there was limited knowledge regarding mental health during that time. Rather, it would have just emphasized Hyde’s malice. Hyde’s choice of accommodation reflects his character as he dwells in a â€Å"dingy street† with â€Å"blackguardly† surroundings. The reader is supposed to infer that Hyde is as sinister and repulsive as his environment. Also, this reveals that he is low-class and unsociable, as most high-class respected citizens lived in much more genial environments, without â€Å"ragged children huddled in the doorways†. Additionally, Hyde’s lodgings represent the duality of human nature. The juxtaposition of the outside and inside of the house reflects how divided man is. On the inside there is â€Å"a good picture hung upon the walls† and it is furnished with â€Å"luxury and good taste† and on the outside there is a seedy gin palace and â€Å"women passing out†¦to have a morning glass†, indicating the house was in an area where poor people, drunks and prostitutes lived, an area where Hyde wouldn’t stand out or attract attentio n. Lanyon’s description of Hyde echoes Hyde’s previous depictions. Lanyon describes Hyde as â€Å"seizing†, â€Å"surprising† and â€Å"revolting† and that â€Å"there was an added curiosity as to his origin†¦life†¦and status†, implying that Hyde was repulsive, yet there was something about him which made whoever saw him to want to examine him. This is a hint about Hyde’s true identity, as at this point of the narrative, readers still weren’t expected to know that Hyde is actually Jekyll’s alter ego. Hyde’s clothes are another hint: they were made of â€Å"rich and sober fabric† but were â€Å"enormously too large for him†. As Jekyll is wealthy he could afford luxurious clothes, and of course they would be too big for Hyde as he is considerably smaller than Jekyll. Lanyon tells of Hyde as having a â€Å"remarkable combination of†¦muscular activity and†¦debility of constitution† , meaning that Hyde was energetic yet appeared fragile and in a poor state of health. On one hand, Jekyll’s description of Hyde is a summary of all the other characters’. Jekyll says that â€Å"evil was written broadly and plainly† on Hyde’s face and that Hyde carried â€Å"an imprint of deformity and decay†. On the other hand, however, Jekyll is attracted to Hyde: â€Å"I was conscious of no repugnance, rather of a leap of welcome†, revealing that Jekyll, rather than being repulsed by Hyde and fighting the transformation, is magnetized by him and embraced the transformation. Also, with Hyde, Jekyll feels complete as he no longer has to battle with his dark side but can accept it is a part of him: â€Å"it seemed more express and single†. Therefore, the reader is not expected to feel shocked when Jekyll says â€Å"human beings†¦are commingled out of good and evil†, as Jekyll has just explained that good and evil co-exist in a person and that it is impossible to be whole without both, linking to the theme of duality. All of us are good and evil, but we decide which side to act on. Hyde’s desires were mostly why Jekyll chose to transform into him. Jekyll doesn’t stipulate what these desires were. What was deemed as socially intolerable and â€Å"undignified† in the Victorian era, might not be viewed that way today. For this reason, Stevenson has not specified what Hyde gets up to or the kind of pleasures he fulfils: so that the text is mentally stimulating to readers, be it Victorians or present day readers. Additionally, Stevenson has withheld the details because they probably would have offended a Victorian audience. Nonetheless, this would be different with a modern audience as a modern audience is exposed to much more than a Victorian one. And, the text is more effective without the details as readers are left to guess, which means Hyde’s secret could be any one of hundreds. Again, Stevenson is being deliberately vague, just as he was with Hyde’s appearance: making Hyde’s secret all things to all readers. In conclusion, by not revealing many details about Hyde, Stevenson created a truly evil character, as humans inherently fear the unknown. When the (few) details are revealed to the readers they are extremely unpleasant, with Hyde being â€Å"deformed†, â€Å"ape-like† and â€Å"repulsive†. Still, the real horror in the story is not Hyde. Jekyll, at the start of chapter 10, describes himself as â€Å"being born†¦endowed besides with excellent parts†¦with every guarantee of an honourable and distinguished future†. Stevenson could have been describing every person in this way, as we are all born expected to be excellent, principled humans, â€Å"with every guarantee of an honourable and distinguished future†. Therefore, in at least one way, everyone can relate to Jekyll. So, the real horror is not Hyde, but rather that every person, good or bad, is a Jekyll and a Hyde.

Instant Solutions for Community Service Essay Topics or Ideas

Instant Solutions for Community Service Essay Topics or Ideas Your stories aren't debatable. You will also make new friends who go to the identical school as you. For instance, you can pick a topic for elementary, middle, or higher school. Sex education is quite sensitive topic. When you get your completed essay, be certain you tell all your friends what an excellent service it is and what's the perfect place to get cheap essays. Why every second person wants a dentist. To summarize, there are lots of approaches to alter the world for the better. Write about the very first time you learned that there are less fortunate individuals on the planet. In school, essay writing has been made to be part of our learning activity. In an issue of speaking, picking out persuasive essay topics is similar to telling yourself what you need to convey to the rest of the planet. All things considered, you can observe that writing a persuasive essay isn't a brain surgery. Perhaps, writing argumentative essays isn't that an effortless job. You are able to also cite the job on specific individuals or philanthropists, that are working with various methods than the ones that you proposed. Outgroup employees sometimes make an attempt to conform. After that, write brief statements of gratitude for each thing and that which you appreciate about doing it. When it has to do with writing an argumentative essay, the most significant point to do is to select a topic and an argument which you can really get behind. Some individuals live their lives depending on their religion while some don't think you should factor that into decision making in regards to determining rules for everybody. Essay writing is definitely thought to be part of academic life and essay writing demands certain abilities or the area of the writer. You first have to figure out the reason behind your essay, before you may write persuasive content about it. Researching the topic will permit you to find out more about what fascinates you, and should you pick something you truly like, writing the essay will be more enjoyable. Still, figuring out the very best topic for your essay isn't your only concern for a student. There are different ways of writing an essay but the fundamental structure stays the same. In that situation, the job of improving the world would come to be much simpler. An individual should always be ready to face all the situations and ought to learn how to remain safe whilst making their contribution to the society. Irrespective of how much you'll be taking that day, there are a few ways that can help you get through the essay with a minimal quantity of stress. Remember your essay is about solving problems, thus a solution ought to be a highlight of the essay. Identifying an issue and proposing one or more solutions ought to be a crucial aspect in your essay. If you wish to concentrate on a particular issue, you will be at fault for doing research on topics that you must find out more about. State issue and explain why a solution has to be figured out. Essay plans can be useful in reminding you of important points that may be used to cover in your essay. Moral argumentative essay topics are a few of the simplest to get carried away with. Persuasive essay is also called the argument essay. Informative essays are somewhat more descriptive. In order to be a member, your high school has to have an NHS chapter. You don't need to find super technical with legal argumentative essays, but be certain to do your homework on what the recent laws about your favorite topic actually say. So far as essay structure goes, a 4 or 5 paragraph essay based on the number of points you are going to want to argue is a great start. You may fill in details and modify the sentence structure after you're clear of what you will need to say.

Hamlet, By William Shakespeare - 1088 Words

Shakespeare writes in a way that is difficult to understand for anyone that speaks the modern language. His story Hamlet is understood through the emotions felt by his characters. Hamlet is the main character who is conflicted with revenge and conspiring friendships. Hamlet returns home from Germany for his father’s funeral only to find far more troubling things. Hamlet is a conflicted character but that doesn’t stop him from knowing what he wants. Revenge is the main cause of his confliction but with great reason, which is important to understand about this play because it helps explain all the betrayal and tragedy. Hamlets father was king married to Queen Gertrude but Hamlet had to return home to attend his funeral. He was a loving son; mourning, only to figure out his mother (the queen) had already married once more. The Queen’s new husband is King Claudius who is Hamlets uncle and the deceased King’s brother. This betrayal was like none other in Hamle t’s eyes. He knew right anyway from a feeling that Claudius was responsible for King Hamlet’s death. Hamlet even worried and sometimes assumed that his mother was part of the planning or even killing of his father. Returning home immediately became about getting revenge on the people that hurt his family and even in some cases that meant his mother. Hamlet was a smart man and very cunning but in the end it doesn’t work out for anyone. When family is taken away from their loved ones it can cause mayhem and ciaos. ThisShow MoreRelatedHamlet, By William Shakespeare880 Words   |  4 PagesWilliam Shakespeare is praised as the pioneering English poet and playwright whose collection of theatrical works is regarded as the greatest artistic value throughout the history of English literature. Shakespeare delved into the spiritual and mental component of humanity and the consequences that arise from this human spirit when it is disputed. The most famous revenge tragedy play, Hamlet, is an excellent illustration of Shakespeare’s philosophical study of human nature. In Hamlet, the arguableRead MoreHamlet, By William Shakespeare899 Words   |  4 PagesWilliam Shakespeare, author of Hamlet, was a well-known author in the 1500s and is still popular today. He was born on April 24, 1564 in London, England. Although there were no birth records at that time, it shows he was baptized one year prior to that, which leads us to believe his birthday was in 1564 because children were normally baptized a year after their birth. Shakespeare’s writing style was very different than others at that time. He used many metaphors and rhetorical phrases, and most ofRead MoreHamlet, By William Shakespeare996 Words   |  4 PagesHamlet, written by William Shakespeare, with out a doubt holds the most famous soliloquy in English history spoken by Hamlet in Act III, scene i, lines 57-90. 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A result from this isolation leads Hamlet to become melancholy. Hamlet struggles with suicidal thoughts, wants to kill King Claudius, and is distraught over his mother’sRead MoreHamlet, By William Shakespeare846 Words   |  4 Pagesalways been a contemplative topic. In Hamlet, the main character Hamlet thinks to himself about suicide. Hamlet was written by William Shakespeare. Shakespeare wrote Hamlet between 1599 and 1602. William Shakespeare is one of the greatest playwrights in history. Hamlet is about Prince Hamlet of Denmark who is trying to find out about the death of his father after his father s ‘ghost’ comes to him telling him it was his uncle who had killed him. While Hamlet contemplates suicide he gives his famous