Post Operative Care After Gall Stone Removal

Post Operative Care After Gall Stone Removal Bianca Robinson Patients who are undergoing operative procedures are required the delivery of ongoing care to optimize their recovery and prevent complications. This delivery of care will enable early identification of circumstances surrounding surgery that may put patients at risk of harm. Mr Whakanna is a 36 year old Polynesian male who has just returned to the ward after having a laparoscopic cholecystectomy. A laparoscopic cholecystectomy is the surgical removal of the gall bladder using laparoscopic technology in a process also known as keyhole surgery (Graham, 2008, p. 47). The aim of this report is to identify and prioritize the problems associated with in the first four hours of Mr Whakaana’s return. It is important for nurses to have an understanding of gallstone disease and the surgical procedure, to ensure that patients are cared for with empathy but also safely and effectively. This report presents the four highest problems that may occur with Mr Whakaana on return to the ward fro m surgery. ABCD’s, Vital Signs and Pain Although different surgical procedures require specific and specialist nursing care, the principles of post-operative care remain the same. It is essential for a structured assessment of Mr Whakaana to be carried out such as that described by Elliot, Aitken Chaboyer (2007) where Airway, Breathing, Circulation, Disability and Environment are examined. This is known as a primary assessment, and is used to identify any signs of airway obstruction, respiratory failure, circulatory failure or neurological dysfunction (Graham, 2008). In this scenario, the nurse must pay particular attention to Mr Whakaana’s airway due to the fact that he has been administered 8mg of morphine, and morphine can cause respiratory depression (Tiziani, 2010). Bradypnoea is a respiratory rate less than 12 breathes per minute in an adult at rest, and is the first sign of respiratory depression; Mr Whakaana should be monitored closely to prevent this (Tiziani, 2010). Mr Whakaana’s conscious state sh ould also be monitored especially as he is currently scored as 1 on the Glasgow Coma Scale, the nurse must pay particular attention to this to ensure that Mr Whakaana does not go into shock (Elliot, Aitken Chaboyer, 2007). It is also helpful to include the patency of drainage systems and vascular devices into your primary assessment of Mr Whakaana, and note if any allergies are known (Elliot, Aitken Chaboyer, 2007). Vital signs should be assessed as often as possible (every half hour/hour) during the first four hours of Mr Whakaana’s return to the ward to determine any signs of deterioration. Vital sign measurements include blood pressure, respirations, pulse, temperature and oxygen saturation levels. Changes in Mr Whakaana’s blood pressure can be used to monitor changes in his cardiac output; pulse assessment can determine Mr Whakaana’s heart rate and rhythm, and can estimate the volume of blood being pumped by his heart (Elliot, Aitken Chaboyer, 2007). Core body temperature differences can occur in illnesses and an abnormal reading can be an indication of infection; Mr Whakaana’s temperature is 36.5C at present, which is within normal range (REFERENCE). Pulse oximeters give a non-invasive estimate of the arterial haemoglobin oxygen saturation, and measurement should always be above 95% (REFERENCE). The nurse should be aware that Mr Whakaana is currently on 3L per m inute of oxygen via nasal prongs, as this could give a false sense of security when recording/documenting Mr Whakaana’s oxygen saturation (Elliot, Aitken Chaboyer, 2007). Pain and discomfort are also important factors in Mr Whakaana’s postoperative period as good pain control is required for an optimal physical and psychological recovery. Post-operative nausea and vomiting (PONV) is common after laparoscopic cholecystectomy because of peritoneal gas insufflation and manipulation of the bowel (Graham, 2008). There are additional risk factors to consider including the use of peri-operative opioids (REFERENCE). Opioids, such as morphine, are a common cause of PONV and so their use, even during laparoscopic cholecystectomy, should be kept to the required minimum. Pain should be measured using an assessment tool that identifies the quantity and quality experienced of Mr Whakaana’s pain. Patients’ self-reporting of their pain is regarded as the gold standard of pain assessment measurement as it provides the most valid measurement of pain (REFERENCE). Self-reporting can be influenced by numerous factors including mood, sleep disturbances and medications and may result in patients not reporting pain accurately (REFERENCE). For example, Mr Whakaana may not report his pain because of the effects of sedation or lethargy and reduced motivation as a consequence of the surgery. Fluid Balance / Output Patients following surgery are vulnerable to fluid and electrolyte imbalance due to many factors, including blood loss, fasting for long periods and exposure during surgery (Walker,2003). Therefore an accurate measurement of Mr Whakaana’s fluid balance is an essential factor in evaluating his condition. This should include strict readings of the output of drains as well as urine and vomit, and the measurement of fluid intake (oral, nasogastric and intravenous). Wound drainage sites and the surgical wound itself should be inspected at regular intervals for excessive blood loss, as this may indicate haemorrhage. Other factors that should be taken into account include diarrhoea, sweating and the use of diuretic therapy. Blood Sugars Diabetes is associated with an increased requirement for surgical procedures and increased postoperative morbidity and mortality (Dagogo-Jack Alberti, 2002). Hyperglycaemia impairs leukocyte function and wound healing (Tiziani, 2010). The management goal for Mr Whakaana is to optimize metabolic control through close monitoring, adequate fluid and caloric repletion, and sensible use of insulin (Dagogo-Jack Alberti, 2002). This assessment is to prevent hyperglycaemia and prevent further complications during Mr Whakaana hospital stay. Infection /Sepsis Conclusion Although postoperative care is a daily occurrence within many areas of practice, it is evident that the theory underpinning nursing actions is often forgotten in daily practice and hence actions may not be prioritised as they should be. It is hoped that this paper has enabled the reader to revisit the principles underpinning postoperative care. Such care must be viewed as a priority, and although there are local policies in place to guide nursing staff, the responsibility for understanding the reasons for actions lies with each individual practitioner. REFERENCES Dagogo-Jack,S., Alberti,K.G. (2002). Management of Diabetes Mellitus in Surgical Patients.Diabetes Spectrum. doi:10.2337/diaspect.15.1.44, Retreived from http://spectrum.diabetesjournals.org/content/15/1/44.full Elliott,D., Aitken,L.M., Chaboyer,W., Australian College of Critical Care Nurses (2007).ACCCNs critical care nursing. Sydney: Mosby Elsevier. Graham, L. (2008). Care of patients undergoing laparoscopic cholecystectomy.Nursing Standard,23(7), 41-8; quiz 50. Retrieved from http://0-search.proquest.com.alpha2.latrobe.edu.au/docview/219887551?accountid=12001 Tiziani, A. (2010). Havards nursing guide to drugs. Sydney, New South Wales: Mosby/Elsevier Australia. Walker,J.A. (2003).Care of the postoperative patient | Practice | Nursing Times. RetrievedMarch28, 2014, from http://www.nursingtimes.net/care-of-the-postoperative-patient/200004.article Walker,J.A. (2003).Care of the postoperative patient Part 2 | Practice | Nursing Times. RetrievedMarch28, 2014, from http://www.nursingtimes.net/care-of-the-postoperative-patient/200004.article

Katznelson White Essay

Ira Katznelson in his article, â€Å"When Affirmative Action was White: An Untold History of Racial Inequality in Twentieth-Century America† published in 2005 by W. W. Norton & Company, London, gives his take on how services were rendered to ex-soldiers of the Second World War. In a nutshell, Katznelson strongly believes that the GI Bill which was enacted in June 1944 to provide a lifeline to US veterans was marred by racial prejudice, although many were led to think that all beneficiaries would be treated equally. Based on the facts that he has presented in this article, I strongly agree with the author that although the program seemed unrivaled in its promise for egalitarianism, it was quickly discerned and employed as a policy â€Å"For White Veterans Only†. Equal treatment under the GI Bill was most likely an illusion. Although there was no racial segregation contained in the new law, the transfer of power to individual states instead of a centralized federal government quarter ensured discrimination against the blacks who sought the services prescribed in the bill. To ensure continuity and a throttlehold of Jim Crow laws, the key lay in bringing different local states and their agencies (which were nearly all-white decentralized units charged with administration) into the set-up. To begin with, a look at the team that spearheaded the making of the legislation is enough to raise eyebrows. The Committee on World War Legislation in the House of Representatives was chaired by a blatant segregationist, John Rankin. Rankin used the Southern approach of decentralizing administration and give racial discharge of the policies to states and localities. The Veterans Administration and the American Legion, which were at the forefront of implementing the GI bill, clearly approved of racial segregation and were reluctant to dispute racial policies embedded in the South. I think this was a calculated move aimed at garnering Southern support to pass the bill in Congress. Like Katznelson, I read malice in the whole affair. If the objective was genuinely to help national heroes, why is it that service was not rendered through direct federal welfare provision? Roosevelt’s government put forth a proposal to manage the postwar benefits for veterans from a â€Å"strong central directive agency† that would collaborate and direct all other agencies. The South would hear none of it. The commander of the Legion proffered a persuasive argument that sought to explain why they preferred individual states to control majority of the elements in the bill. Apparently they intended to coin the law in line with the South’s racial rules and customs. Racism had severely taken shape in the US and one bill may not have been enough to ensure equality of the subjects. Several lobby groups expressed their reservations concerning the new bill with valid reasons. They explicitly ascertained that racial bigotry in the South prevented Negro veterans from acquiring full benefits under the GI bill. I feel that the barriers that black veterans faced in trying to access services described in the GI Bill clearly ridiculed the legislation’s â€Å"open-hearted promises†. How is it that an initiative that sought to help white and black ex-soldiers alike is the same scheme that ensured that blacks would never benefit from the rewards of its provisions? In the education front for instance, I see that a profound world of discrimination along the lines of color existed. Prior to the war, most blacks failed to join college due to lack of funds; but thanks to the federal disclaimers a large number of returning veterans would take advantage of the opportunities. Consequently, it would only be logical to develop the institutions to hold the new entrants. Unfortunately, in black colleges the budget, facilities, staff, fields of specialization offered among other prerequisites remained the same despite the overwhelming number of people who were interested in enrollment. Moreover, instead of rooting the Supreme Court’s policy of separate schools for white and colored persons, individual states fortified it. In Mississippi alone for instance where black population was more than 50%, only 7 out of the 33 institutions were allocated for blacks. Poor and inadequate facilities, less and unskilled personnel, lack of space, and denial of state support were among the many reasons that most black institutions were incapable of admitting all the qualified veteran soldiers. Very few colleges were endorsed by the Association of American Universities. Furthermore, hands-on training was also offered for those who did not have the minimum qualification for college entry. However, in the agricultural sector where a significant number of veterans applied, blacks were faced with the problem of perverse white administration. In my opinion, the whites indeed felt threatened by the fact that blacks would access better wages and they would be able to own farms. With money in their pockets and a higher social standing, blacks would not be willing to take up menial jobs as farm laborers and housemaids; and as such whites offered on-the-farm and on-the-job training for very few of Negro veterans. Since nothing had been done to challenge local racial customs, white owners of businesses who were the majority at the time disinclined to accept black trainees. Additionally, vocational schools too reeked of impediments for interested blacks. According to Katznelson, surprisingly black veterans were exploited by training schools that offered little or no actual training while swindling them of the GI bill grants. Because the VA could not directly impose rules on state schools, the majority of state departments mandated to supervise and consent worthy institutions disregarded the recommended standards. As such, these schools became profit-making ventures at the expense of African Americans. What’s more; for black veterans who wished to set up the own business ventures, they were denied access to loans promised in the GI Bill. Banks rejected them on the basis that they did not have adequate personal capital, credit ratings and good environments for the establishment of their investments. In conclusion, I concur with Katznelson that the GI Bill indeed presented the black veterans with the best opportunities they would ever access. It was, as Michael Bennett put it, â€Å"America’s first color-blind social legislation†. African Americans and whites alike were offered sponsored mortgages, investment loans, benevolent educational grants, and job training; a feature that was not typical of the society at the time. Nonetheless, the manner in which the program was set up and overseen completely undermined its initial intent. It is common knowledge that â€Å"new wine is not put into old skins†; similarly for the promise of fair treatment to be realized, its implementation needs to consider these primary narrow-minded racial practices and traditions. References Boulton, M. (2008). How the G. I. Bill Failed African-American Vietnam War Veterans. The Journal of Blacks in Higher Education, 58, 57-61. Katznelson, W. (2005). When Affirmative Action was White: An Untold History of Racial Inequality in Twentieth-Century America. London: W. W. Norton & Company.

The Foolproof Argumentative Essay Samples for Gre Strategy

The Foolproof Argumentative Essay Samples for Gre Strategy Argumentative Essay Samples for Gre and Argumentative Essay Samples for Gre - The Perfect Combination This tutorial can help to pick a suitable topic question. Writing an outline is a rather effective means to think through how you'll organize and present the info in your essay. Lesson Summary To review, so as to use numerous sources effectively when writing a persuasive paper, you're want to first conduct research to discover credible sources or thoroughly review any sources that were offered to you. Choosing topics is an individual skill you should learn and practice at school, so quit procrastinating and stick to the simple tips below to be able to produce fresh ideas and make a great topic to work on. Argumentative Essay Samples for Gre Help! Simply type example of an argumentative essay and you'll find distinctive sorts of samples. When looking where to purchase argumentative essays, you have probably already encounter number of different sites that provide similar services and even checked their sample essays. Samples are the tools that produce the whole writing process simpler. Each sample is meticulously written by an identical expert freelance writers that you will be matched with upon placing your purchase. It's fine to jot down simple thoug hts and sentence fragments. It is essential that the thesis statement ought to be slimmed down so as to stick to the guidelines of the given writing exercise. Think about the place of the audience reading your paper and whether there is enough applicable proof to back up your thesis. Bear in mind, the most important goal is to prove your thesis is a valid argument. Most Noticeable Argumentative Essay Samples for Gre On-line documents There are sample argument essays which can be accessed through internet links. Be aware that excerpt is a fancy word for a brief piece taken from a lengthier work. You've sought out a service from where you are able to buy argumentative essay samples and now you wish to acquire the absolute most out of it that you're able to. For your debate to be a strong one you always need to double check to see whether there are enough data and information that can back up your viewpoint. The distinction is that the thesis of an argument essay is known as a CLAIM. Argumentative essays also incorporate a kind of thesis. Argumentative essay examples are employed within this guide to help you realize how to write one. First paragraph consists of strong thesis statement which will be proved further in essay. Whether it's an argumentative or expository essay that you're writing, it is essential to develop a clear thesis statement and a crystal clear sound reasoning. Before concluding the essay, it is crucial to summarise with a strong emphasis on the subject. There's a logical transition between each component of essay. Make certain you are aware of what the distinctive qualities of an argumentative essay are. If you would like to learn more about the argumentative essay read a brief summary on four essay types within this guide. No matter the quantity or kind of research involved, argumentative essays must set a very clear thesis and follow sound reasoning. An argumentative essay doesn't include unsubstantiated opinions. Whatever They Told You About Argumentative Essay Samples for Gre Is Dead Wrong...And Here's Why If you believe you need more, you are able to even choose an expert essay writer holding PhD degree in requested area. This essay will appear at a number of the explanations for this difference at university level. Don't forget, your major argumentative points ought to be driving your essay. So when you purchase sample argumentative essays from Ultius, you will have the peace of mind you have earned from a comprehensive writing service. Facts, Fiction and Argumentative Essay Sam ples for Gre When you've decided on a subject, think about the advantages and disadvantages of the problem. There's a remarkable remedy to your issue! When choosing an issue to argue, you must pick a topic that has more than 1 side. Definite topic and any type of prompt given in class would be a terrific start.

The Problem Of Social Class - 1189 Words

Running Head: Misfortune of the Unfortunate Hurricane Katrina and the Misfortune of the Unfortunate Ibrahim Farag University of Louisville Inequality has been a topic of discussion in the United States—as well as the vast majority of the world—for a significant period of time now. While there is no denying that inequality exists, I believe that it has become assumed to be the underlying problem in a lot of cases where it doesn’t necessarily apply. There are a number of problems in society that can’t be fixed because the solution is designed around the idea that inequality is the issue, and if people were to identify the true underlying problem in a lot of cases: social class, then we can concoct a solution to address the†¦show more content†¦Reed doesn’t completely dismiss the significant role that race plays in shaping the economic and social hierarchy in New Orleans; ultimately class is the more effective characteristic however, in predicating who was capable of evacuating the city prior to the hurricanes arrival, who was capable of surviving the hurricane itself/remained in shelters elsewhere, whose interests will be taken into account regarding the cities reconstruction, and who will be capable of returning to New Orleans. (Reed 2006) Essentially the real reason people stayed in New Orleans as opposed to evacuating, wasn’t because they chose to do so, but because they didn’t have the means to. Reed clearly emphasizes that in New Orleans, there is clearly â€Å"no lack of racial inequality, or frankly racist ideology† (Reed 2006). However, the reason racism was so dramatically deemed the factor responsible for the inequality and injustice, is because â€Å"in the contemporary United States race is the most familiar language of inequality and injustice† (Reed 2006). Meaning race was the easy choice to explain what happened is because in modern U.S. we are used to race being the predominant source of inequality and injustice. Reed believes that the race critique doesn’t explain the deep