Hydration Management in Acute Stroke Patients

Hydration Management in Acute Stroke Patients Introduction Stroke is a global public health concern with many sufferers presenting with varying levels of confusion (Oh and Seo 2007). Management of hydration in acute stroke patients is not standardised and variations in practice can be very wide between different continents. The sheer number of possible comorbidities and the relative ease with which hydration can trigger concomitant problems can lead to increasing incidence and prevalence of long-term patient care resulting from inadequate hydration management. Optimum hydration assessment and management are key clinical activities; however, inadequate hydration controls by health professionals persist (Oh and Seo 2007). Research shows that to guide fluid management to desired levels, a regular assessment of the volume status has to be made Scope This literature review is based on works that are found on Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health literature (CINAHL), Cochrane, Department of Health (DoH), National Institute of Clinical Excellence (NICE), National Medical Council (NMC), World Health Organisation (WHO), Wiley Interscience and CKS databases that relate to hydration in stroke patients and nursing awareness of hydration in stroke patients. There is wide literature on different aspects of stroke and many authors have studied the effects of hydration in stroke patients. This review looks at literature that discusses management of hydration and/or the impacts of variations in hydration management on acute stroke patients outcomes like method of feeding, time- compliance in taking readings or measurements, legal issues and ethical issues. Relevance to clinical practice This literature review looks at relevant studies by experts that are found on credible databases. The purposes of the expert studies are reviewed and analysed to inform better understanding of current nursing practice in hydrating acute stroke patients. Several studies on hydration highlight specific difficulties relating to the assessment and management of hydration in acute stroke patients. There are differences between the management and the assessment of hydration in different hospitals and these complicate improving awareness of managing hydration for nurses in practice. If optimum hydration is directly linked to improved outcomes in acute stroke patients, research will be required to identify and overcome barriers to effective hydration management, including the development of specific tools (and knowledge base) to facilitate interventions that promote optimum hydration in seeking improved outcomes in acute stroke patients. Methods of search and documentation n on-line literature search of MEDLINE, CINAHL, COCHRANE, DOH, NICE, NMC, WHO and CKS from 1999 to May 2009 failed to identify enough relevant articles on hydration in stroke patients. Other sources were then reviewed for available literature on medical journals including the BMJ and American Family Physician. For the on-line computer-based literature searches, the following keywords were used: stroke, fluid balance, hydration, cerebrovascular accident (CVA), dehydration, stroke outcome, cerebrovascular disorders, medical management, artificial nutrition and hydration, dysphagia, dysphasia, pyrexia, acute brain infarction, enteral tube feeding, fluid and electrolyte balance, neurology, withholding treatment, pathophysiology and nurses and hydration Hydration and hydration management in acute stroke patients This literature review looks at one of the issues encountered globally in the treatment of acute stroke patients optimum hydration. It takes a particular look at the nursing awareness, measurement, assessment, methods of intervention and the legal issues associated with hydration in acute stroke patients. Stroke is a debilitating condition and can be caused by an ischaemic event or a subarachnoid/intracerebral bleeding. Stroke patients usually present in hospital with co-morbidities (Oh and Seo 2007). Variations exist in stroke fatalities across geographical regions even within the same continent. Studies by Bhalla et al (2003) across four European centres (London, Dijon, Erlangen and Warsaw) have shown significant variation (after adjusting for case mix) in stroke case fatality, in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity. There were also significant intervention differences between centres in intravenous fluid use, enteral feedin g, initiation of new antihypertensive therapy and insulin therapy, with the London centre having the lowest uptake of interventions. In another European BIOMED Programme, significant variations in case fatality for stroke between European centres (after adjustment for stroke severity) were observed, with the United Kingdom (UK) centres having the highest case fatality and the lowest levels of independence (Wolfe et al., 1999). There were lower intervention rates in the UK centre to correct abnormal physiological parameters in the acute phase which may reflect a difference in philosophy of acute medical supportive care compared with other European countries (Wolfe et al., 2001). Awareness of optimal hydration balance and assessment of the patients hydration condition (in the care of acute stroke patients) is a fundamental part of critical care nursing and optimising the hemodynamic situation can be seen as a team-effort. One of the important factors determining quality of the circula tion is the amount of circulating blood (Hoff et al 2008). Following a stroke, patients may have swallowing impairment and other changes of the gastro-intestinal (GI) tract that could affect nutritional and hydration status and that lead to aspiration pneumonia (Schaller et al 2006). Such changes affect the ability of the acute stroke patient to lead a normal nutritional life. Although the Schaller et al (2006) work did not show a direct link between hydration and other comorbidities, they agree that impaired hydrational status is associated with reduced functional improvement, increased complication rates, and prolonged hospital stays. Hydration and hydration status Hydration balance is a measure of the bodys ability to manage fluids and electrolytes. In order to identify the urgency of interventions, nursing staff should characterize an individuals fluid and electrolyte imbalance as mild, moderate, or severe based on pertinent information including lab tests and other relevant criteria. It is important to recognize that the main electrolyte in extracellular fluid (ECF) is sodium and that of intracellular fluid (ICF) is potassium (Edwards, 2001). Toto (1998) pointed out that large increases or decreases in fluid volume can cause infarct, coma and confusion. This knowledge becomes significant in maintaining cerebral blood flow and in preventing secondary brain insult after an acute stroke. In a complication, respiratory or metabolic acidosis will promote the movement of potassium from the ICF and give rise to high serum potassium levels, which may affect cardiac function (Edwards, 2001). This phenomenon can be seen in many traumatic insults to th e brain. A basic knowledge of this physiology in addition to the homeostatic mechanisms for fluid and electrolyte balance is a vital foundation for nursing practice, and essential to the nurses role in hydration management. Cook et al (2005) highlighted the significance of fluids and hydration in the neuroscience patient and in Cook et al (2004) they highlighted that an understanding of the physiological mechanisms that surround stroke is important for nurses to monitor and treat such patients. Kelly et al (2004) in their study of dehydration and venous thromboembolism (VTE) after acute stroke believed dehydration after acute ischaemic stroke (AIS) is strongly independently associated with VTE, reinforcing the importance of maintaining adequate hydration in these patients. Their study of hydration over a 9-day period showed indication that dehydration was largely hospital acquired and that the association was causal. Although the possibility that VTE was already present at entry to hospital cannot be discounted, tests have shown that VTE is rarely present before the second day post stroke, and then it becomes increasingly prevalent over the next few days. This could be for one of many reasons including poor communication between patient and hospital staff, change of environment for the patient and the physiological impacts of stroke Hydration balance and nutritional/electrolyte balance The differences in how hydration is assessed in different hospitals have been subject of study for some time. The significance of fluid electrolyte homeostasis becomes very relevant in trauma and shock situations such as subarachnoid haemorrhage where an inflammatory response is triggered which causes a significant change in capillary membrane permeability in a short period of time. In such situations, water, electrolytes and albumin move into the interstitial space to permit the site of injury to receive the required factors (third space shift) (Edwards, 2001). A number of physiological mechanisms are required to maintain homeostasis of hydration status, all of which inform proactive nursing assessment, intervention and evaluation. Those with trauma to the nervous system are vulnerable to disruption to the homeostasis of fluid and electrolyte balance (Cook 2005). Older adults may have a poorer capacity to adapt to shifts in acute fluid balance, leading to the possibility of cardiac and renal functions being impaired and, as a result, a lower glomerular filtration rate (Sheppard, 2001). Managing the fluid balance of the stroke patient by intake and output measures needs to be exercised cautiously because even though the patients fluid volume may not have changed, his/her circulatory volume may be significantly lower in instances of major trauma (Edwards, 2001) Good hydration has been shown to reduce the risk of urolithiasis (category Ib evidence) (see Appendix 2), constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence), and is associated with a reduction in urinary tract infections (UTIs), hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct Complications of measurement/control Naso-gastric v PEG, enteral v parentera Patient history taking on presenting in the hospital differs from hospital to hospital. History taking should include assessment of fluid intake and loss, baseline hydrational status, skin turgor, heart rate, blood pressure and urinary output. Normal fluid intake for the average adult is approximately 2-2.5 litres, obtained from food, fluids or metabolic by-products (Edwards, 2001). Methods of measurement are not standardised across hospital settings with Wise et al (2000) showing that faecal fluid losses are often neglected in daily fluid balance charts with the possibility of inaccurate hydration assessment. Fluid assessment must include estimating, as accurately as possible, the quantity of fluid taken in. It must take into consideration the entire processes by which water, potassium and sodium are obtained. Measurements are often mainly focused on the extremes of hydration (optimal hydration and extreme dehydration) and this should not be the case. Assessment of hydrational statu s and need is continuous and begins somewhere along a continuum of severe hypovolaemia/ dehydration to severe hypervolaemia/ overhydration. In looking at dehydration, not only extreme dehydration should be noted. Manz and Wentz (2005) highlight that there is increasing evidence mild dehydration may also account for many morbidities and play a role in various other morbidities. The way in which stroke is managed acutely, such as measures maintaining physiological homeostasis may also vary between different populations (Bhalla et al 2003). The physiological indicators of acute deficits in fluid balance may be masked in individuals where compensatory mechanisms are intact. A history of acute events, mainly from baseline documentation and history taking, may enable better identification of such imbalances (Sheppard, 2001). Fluid and electrolyte homeostasis is brought about by the interaction between the renal, pulmonary, neuroendocrine, integumentary and gastrointestinal systems (Edward s, 2001). According to (Cook 2005), fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Artificial feeding and fluids are the options for a patient who has an advanced, life-threatening illness and is dying. The patient, family members and doctor can talk about these options and the benefits and risks (Ackermann 2000). Hydration and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. Edwards (1998, 2001) highlighted that homeostasis is maintained by a constant movement of water, sodium and potassium between intra- and extracellular compartments. While the movement of water and electrolytes between the cellular compartments is highly significant, it is important to recognize that in acute and chronic illness intracellular fluid (ICF) is reduced and extracellular fluid (ECF) increased almost to the extreme (Edwards, 2001). This is highly relevant for cerebral metabolism, because transport of oxyge n, glucose, proteins and other products for cellular metabolism—and their by-products—may be severely impaired. Stroke may affect ones level of alertness, perception of thirst, ability to access liquids, and ability to swallow them when offered. Stroke victims with such impairments may be at increased risk for diuretic-induced dehydration (Churchill et al 2004). Managing hydration balance is of crucial importance and the mechanisms for the adequate monitoring and controls need to be in place. Nursing management questions in the assessment of hydration in acute stroke patients should include whether use of intravenous fluids during the first week of stroke was recorded. Questions should also include whether the patient was fed orally, by nasogastric tube, through percutaneous gastrostomy tube, by intravenous methods or not at all? The fact that these questions can be raised enforces the need for adequate documentation and recording of acute stroke patient records. Bhall a et al (2002) says that the use of artificial ventilatory support with intubation or nasal intermittent positive pressure ventilation should be documented as well as the use of supplemental oxygen given through nasal catheters or masks. Enteral tube feeding is a vital means of feeding and balancing hydration levels in patients with stroke. There are no set standards for hospitals in the UK and hospitals have recorded much variation between them in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used (Ebrahim and Redfern 1999). Some clinicians delay tube feeding for 2 weeks or more, and although early nutrition is unlikely to be harmful, whether any nutritional benefits offset the difficulties and complications of initiating and maintaining early enteral tube feeding is unclear. If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers o f patients are being denied best treatment. Whether enteral tube feeding via PEG rather than nastrogastric tube or early initiation of enteral tube feeding improve outcomes was tested in the FOOD trials and no evidence of significant benefit from PEG rather than nasogastric tube feeding was found. Neither was any hazard from early tube feeding found (The FOOD collaboration 2003). The explanation for any difference between PEG and nasogastric groups is not clear, but one factor might be the effect of a long-term PEG tube on dependency since more patients in the PEG group were still receiving such tube feeding than in the nasogastric group at follow-up (The FOOD collaboration 2003). The survivors in the PEG group were also more likely to be living in institutions and had lower quality of life. Another intriguing finding was the excess of pressure sores in the PEG group, raising the possibility that those with such tubes might move less or be nursed differently. Weaknesses in this test results include insufficient statistical power to exclude more modest differences between groups; no information about the proportion of eligible patients enrolled in each centre; our use of an informal (although reliable and highly predictive) assessment of nutritional status; absence of precise monitoring of patients daily intake of nutrients (rather than fluids); absence of on-site source data verification or collection of information on changing nutritional status (e.g. in-hospital weights); possible bias due to masking of secondary outcome measures. Although compliance was not 100%, this fact results from the inevitable difficulties of adhering to rigid schedules when patients conditions change. Difficulties with nasogastric feeding in stroke patients (who are often confused and uncooperative) have led to increasing use of PEG tubes at an early stage. Enthusiasm for this method has been encouraged by the results of a trial that reported much lower case fatality rates in patien ts fed via PEG (13%) rather than nasogastric tube (57%) (The FOOD trial collaboration 2003). Due to significant alterations in fluid balance after enteral tube-feeding in patients, close attention to the recording of fluid balance such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage (Oh and Seo 2007). One explanation for the varying and inconsistent readings in fluid hydration between enteral and PEG might b Stroke patients and the impacts of stroke on life Difficulty with swallowing is a common problem in acute stroke patients, and can lead to aspiration pneumonia, dehydration, and exacerbation of any existing malnutrition (Finestone and Greene-Finestone 2003). In Oh and Seo (2007) the authors set out to examine the fluid and electrolyte complications after enteral tube feeding in acute brain infarction patients. The background is that inconsistencies in the results of the water and electrolyte complications associated with enteral tube feeding are partly because of uncontrolled disease-related variables. The implication is that these variables were not adequately managed. Stroke patients very often present with dysphagia and this is very commonly dehydration associated with undernutrition (The Food Trial 2005). Up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods (Mann et al 1999). Although a 50% prevalence can be considered to be high, th e nutritional/fluid status of a stroke patient can rapidly deteriorate in hospital. The difficulty in feeding stroke patients with dysphagia coupled with the discomfort associated with stroke can exacerbate undernutrition and/or dehydration. Studies show that undernutrition shortly after admission is independently associated with increased case fatality and poor functional status at 6 months (The FOOD trial collaboration 2003). The current financial burden of efficiency savings and reduced budgets in the NHS hospitals results in reduced staff numbers so that patients can not be attended to on a one-on-one basis so that ensuring appropriate hydration levels is done by periodic but regular monitoring of charts. An option for the future in this area may be to involve the patients family members in hydration monitoring and provide them with appropriate training if evidence can show that being around loved ones improves outcomes and early warnings. In acute stroke, artificial nutrition t hrough an enteral route is needed because of dysphagia and since oral feeding is unsafe in some dysphagic patients, enteral nutrition is often administered as nasogastric or percutaneous endoscopic gastrostomy (PEG) tube feeding (Finestone and Greene-Finestone 2003). Naso-gastric tube feeding (a prevalent enteral method) has been reported to improve clinical outcomes more than the parenteral route in brain-injured patients (Rhoney et al 2002). Oh and Seo (2007) in their study used 85 subjects, but their work was limited by the fact that it was performed retrospectively and some of the subjects records were incomplete. Also, because the patients in the study were from one hospital it is not conclusively known whether the results can be generalised to the whole population./p> Legal and other aspects Japanese physicians attitudes towards artificial nutrition and hydration (ANH) as a life-sustaining treatment (LST) were examined to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. The study findings show that the informants held different views towards LST because most doctors considered ANH to be indispensable and ANH is automatically provided to patients (Aita and Kai 2006). With the advancement of medical technology, decisions to withhold or withdraw LST are among the most difficult to make for health professionals (British Medical Association 2001). Physicians caring for stroke patients often encounter comatose or semi-comatose patients with severe stroke for whom it is difficult to determine whether or not to continue care (Asplund and Britton, 1989). By administering LST, some patients in this patients group, whose bodily functions other than brain function could remain stable, could pot entially survive for months or years without achieving awareness or being able to interact with others (Aita et al 2008). Certain Japanese physicians have criticized the current efforts regarding life prolonging as Aita et al (2008) states: Prolonging the process of dying like this constitutes the violation of dignity and human rights. The life-prolongation only serves hospital operators who want to make profits by keeping hospital beds occupied. They also said this practice impacted the carers and that some nurses also feel emptiness toward the manipulative life-prolongation when taking care of these elderly patients. In the West, some countries have worked out nation-wide guidelines related to withholding or withdrawing LST that say stroke-caused profound impairment with no hope for recovery is a potential reason to withhold or withdraw LST (British Medical Association, 2001). Ackermann (2000) believes withholding and withdrawing therapy challenge family physicians to be excellent communicators with patients and families and recommends that family physicians should continue to be strong advocates for dying patients. Sprung et al (2003) highlighted differences between withholding and withdrawing therapy showing that withdrawal of therapy is followed by a nearer and more rapid death than withholding therapy, and that physicians and nurses were more inclined towards withholding rather than withdrawing therapy. Food and water are considered symbols of caring (Ackermann, 2000), therefore, it may be natural for physicians to give a special status to ANH as food and water. Whether to withdraw ANH from a patient in persistent vegetative state has also drawn substantial media attention in the U.S. (Casarett et al., 2005; Ganzini, 2006). The findings of the study also suggest that the physicians double standard is partly based on their subjective judgment whether the treatment is ordinary or extraordinary. However, the standard of ordinary/extraordinary care has long been criticized as too vague to guide decision-makers in the U.S. (Beauchamp and Childress, 2001). It is believed the current legal framework has also inappropriately led some physicians to simply continue care regardless of the patients conditions, thus resulting in putting an unnecessary burden on patients. The physicians subjective interpretation of the current legal framework may lead to decisions not to initiate mechanical ventilation in some older adults for fear of facing a situation in which physicians cannot withdraw it at a later stage Conclusion Hypovolemia and hypervolemia occurred frequently after acute stroke but were often not recognized as such by nurses. The nurses predictions of current volume status do not seem sufficiently reliable to serve as a basis for therapeutic decisions. More advanced techniques for bedside assessment of volume status may be indicated for optimizing volume status in patients with acute stroke (Hoff et al 2004). Whereas studies have looked at the optimal method of improving hydration, whether correcting dehydration in stroke improves outcome is not very clear. Given the complexity of the cell death cascade following brain ischemia, novel approaches and combination therapy are inevitable for victims of stroke (Fisher and Brott 2003). The review indicates that standards vary from country to country in the legal framework for withdrawing and withholding hydration and nutrition during end stage care.

Personal Space and the Impact of Eye Contact Essay

As being a very important part of the human’s behavior, Personal Space and eye contact attracted a lot of scientists and research institutions. As Jeff Hughes and Morton Goldman (1978) have shown that how variations in eye contact and of experimental confederate affected the violation of personal space. Different people have different definitions to the term ‘Personal Space’. Personal Space may be denned as the area individuals maintain around themselves into which others cannot intrude without arousing discomfort (Hayduk, 1978). Personal Space is often described as a bubble of space surrounding a person. Buchanan, Goldman & Juhnke (1977) defines Personal Space as ‘a physical space surrounding an individual which, when intruded upon, generates an observable reaction of discomfort or flight’. The first factor to be considered that influences a person’s personal space is body position. Whether a person is sitting down or standing up can greatly affect their personal space. Hartnett, Bailey and Hartley (1974) claims that â€Å"for both the short and tall Os, the subjects were approached closer in the sitting position. From a territorial point of view, it could be that people believed that they are not really invading the personal space of others when they were in a position that seemed less threatening, which is sitting. The second factor to be considered that affects personal space is physical disability. Wright (1983) suggests that bad attitudes and perceptions about people with physical disabilities are highly retentive, and cannot be easily removed or changed. Kleck (1968) has also confirmed that people tend to give more personal space in social interactions to people with physical disabilities as compared to people without physical disabilities. A variable that has not been frequently manipulated in personal space research is eye contact. As seen in field experiments conducted by Buchanan, et al. (1977), males generally prefer to violate the personal space of another male who did not offer much eye contact, rather than another male who offered direct eye contact. Another experiment conducted by him shows that â€Å"female subjects preferred to violate the personal space of a female confederate who established eye contact with them†. It is also seen that females tend to avoid invading the personal space of males who had direct eye contact with them. However, females would rather violate the personal space of a male who are smiling at them and gazed directly at them, as compared to a male who had their backs turned. And according to Argyle and Dean, the eye contact is significantly reduced as proximity is increased and their finding that eye contact unpleasant or is to be avoided as proximity increase suggests that variations in the way a person gazes at others could affect intrusions into that person’s personal space. From these readings, it is expected that when two people approach each other with eye contact, the personal space between them will be bigger than without eye contact.

Cancer

Cancer is a disease that affects millions of people worldwide. Hodgkin's disease (Lymphoma) is one of its forms. Lymphoma is essentially a type of cancer that begins in the lymphocytes (infection-fighting cells). These cells proliferate uncontrollably and are found in the lymph nodes, thymus, bone marrow, spleen and other parts of the body. When first diagnosed, information from tests is used to estimate a prognosis. This is often referred to as the extent of the lymphoma; staging is based on how much lymphoma there is in the body and where it is located. These tests are used to determine the size of the tumor, and if it has spread and where. After a proper diagnosis, a health team will then use the stage plan treatment. In order to diagnose, health team professionals look into the number of lymph node groups that have lymphoma; and if the lymphoma has spread to other areas of the body, including vital organs and tissue. The most common staging system for Hodgkin lymphoma (HL) is the Ann Arbor staging system. Normally, the higher the stage number, the more the disease has progressed. The first four stages are written in Roman numerals I, II, III and IV. During stage 1, lymphoma is in one group of lymph nodes, 1E: lymphoma is found in only one area outside of the lymph nodes (Lymph nodes with lymphoma are either entirely below or above the diaphragm) Stage 2: Lymphoma is in 2 or more groups of the lymph nodes, 2E: The lymphoma has also spread into tissue nearby, Stage 3: Lymphoma is found in both above and below the diaphragm, stage 4: The disease spreads completely and found in vital areas such as the bones, liver, lungs or cerebrospinal fluid. The Cerebrospinal fluid is a colorless, see through body fluid found in the brain and spinal cord. At this point the disease is usually fatal. This fluid serves a vital function in cerebral blood flow and autoregulation. The most common symptoms of this stage include confusion, other behavioral and personality changes, symptoms associated with pain and pressure within the brain (such as: Drowsiness, fatigue, nausea, vomiting, and headaches) losing eyesight and experiencing seizures may also occur. There is also an alphabetical category that divides HL. These letters may be added to the stage number: A- including no excess of sweat, weight loss, or fever. B- Inexplicable long-lasting fever, night sweats and weight loss. E- The lymphoma is found in tissue nearby the lymph nodes, commonly referred to as the ‘extranodal site' this is the involvement of the spleen, stomach, nervous system, lung, skin, bone, and Waldeyer's ring (which is the collection of lymphoid tissue surrounding the tonsils. S-The Lymphoma has fully spread to the spleen. X- Bulky disease spreads; it is essentially a larger version of the disease.On a day by day basis, research looks for better ways to stage and diagnose HL. Researchers are also trying to find ways to help doctors predict a more accurate prognosis (which, as mentioned above, is the probability rate that the cancer can successfully be treated and will not come back after treatment).Lymphocytes are one of the many white blood cells. They all have a different function. Their purpose is to fight disease and illness. The numerical ratio of lymphocytes to monocystesin in the blood may contribute to the prediction of a prognosis for different types of HL in various age groups. The use of this ratio helped doctors predict both progressive-less survival and overall survival rates. This ratio has also found that higher ratios of lymphocytes than monocytes are linked with better overall survival, especially in people younger than 60 years of age. Additional study is needed before doctors can use this ratio as a common tumor marker for predicting prognosis. Biomarkers are molecules found in body fluids and tissues. They determine whether there are molecules found in body fluids and tissues. They determine whether there are signs of a normal or abnormal process, or a disease. A biomarker is often used to see how well the body responds to treatment for a condition. Cells, tissue, genes, fluids, chromosomes and proteins are all biomarkers. Researchers study different biomarkers to try to find which ones are helpful at finding cancer or predicting prognosis and responses to treatment. A person with cancer usually contains abnormal amounts. For example, a protein may be found in higher than normal amounts or a chromosome that should be there is missing. At the present time, more than twenty tumor markers are being used to make cancer treatment-based decisions. Most tumor markers are concrete to one type of cancer, whereas others are related to several ones simultaneously. However some types of cancer don't have any known tumor markers yet. In order to better understand them, health specialists are looking at genes, proteins and other properties that could in prospect be used as tumor markers. This is formally known as tumor biobanking. Newly developing tumor marker tests can help doctors identify cancer earlier, improve prognosis and predict a more accurate diagnosis. By identifying targets for targeted therapy drugs, treatment can easily be chosen. They are part of the growing of medicine. Microarray analysis is a gene-based test that allows researchers to look at many genes at once. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. This test can find genes that are turned on or off because of gene mutations or other genetic changes that may be related to a certain type of cancer. Doctors sometimes look at an entire gene or many genes together, along with DNA to see if there are changes. Gene-based tests differentiate healthy genes and genes that have been mutated into cancer cells. Genes are DNA pieces that tell each cell in your body what to do. Doctors can also use genes that are changed or mutated as tumor markers. Researchers have linked some genetic changes or mutations to cancer, but we are only beginning to uncover the full picture of which genes may or may not be involved. Researchers aspire to identify the best treatments and that more of them will be tailored to each person's cancer. A liquid biopsy, tests the blood or other body fluids for cancer. (called circulating tumor DNA) It looks for any signs of tumor in the DNA and in the blood and can be done on a sample of blood removed during a blood test. In a standard biopsy, a doctor removes tissue from the body with a procedure that usually involves surgery or a needle. Doctors then recommend treatments based on what this sample of tissue tells them about the cancer. A liquid biopsy is an exciting alternative to a standard biopsy. Researchers want to find out if using a liquid biopsy can find cancer as well as a standard biopsy does. Even if it can, a standard biopsy will probably be used for most people because it gives doctors a lot of useful information about the cancer. Although, having a liquid biopsy may be a good option for someone who isn't well enough to have a standard biopsy. A liquid biopsy may also be used if there isn't enough tissue to remove and test or if the tumor is in a place that makes a standard biopsy hard to do. A possible advantage of liquid biopsy may even be that it could provide information about the tumor that a standard biopsy can't. During a standard biopsy, only a small piece of the tumour is removed and tested. Tumor DNA that is circulating in the blood may contain different information that isn't seen on the tissue sample. A liquid biopsy may be most useful in looking for cancer that has come back as part of follow-up care after treatment has ended. Since tumour DNA may not be found in the blood right after treatment, it's best to test for tumor DNA a while after treatment is done. There's also a robotic biopsy that's supposed to remove cells or tissue to look at under a microscope. A robotic biopsy is often done by laparoscopy through five to six small surgical incisions. During robotic surgery, the doctor sits at a computer station close to the operating table, watches a monitor with live video and uses controls to move about three robotic arms that are connected to surgical instruments that remove tissue. Imaging is a way for doctors to find the exact location of cancer and to check for cancer that has spread. This Information from is used to stage cancer and help plan treatment. Imaging tests and devices, such as x-ray, MRI, ultrasound and CT scans, are a common way to zero in and confirm any diseases, including cancer. Imaging uses specific machinery and techniques to create images of the body's insides to see everything going on in it. Research has worked hard in developing new imaging tests and continues to study modern imaging tests to see if they can find better ways to diagnose cancer, predict prognosis and plan treatment. During virtual endoscopy (an imaging test that uses a CT scan to create images of the inside of an organ) A computer reflects a three dimensional picture of the organ from several images. Doctors can use this three dimensional view to look at the lining of an organ similar to the ways they would during a regular endoscopic procedure. The only difference is that no endoscope is inserted. Researchers are looking at virtual endoscopy as one of the more practical ways to diagnose and stage most cancers. Radiation therapy treats most types of cancer quite effectively. But like other treatments, it often comes with its side effects very much different for each person. This varies depending on the cancer type, location and the radiation therapy dose, and your health, really. This is the reason why it is always a goal to only use if essential. To lower radiation doses, many imaging tests, such as CT scans and x-ray, use radiation. Imaging machines that use high doses of radiation, such as CT and nuclear medicine imaging tests, are being used more often than they were in the past. So researchers are trying to develop better guidelines to protect people from medical radiation, such as using these tests only during dire circumstances, tailoring radiation doses to each person based on their height and weight so that as little radiation as possible is used, using other tests without radiation such as ultrasounds. It's crucial to keep track of how much medical radiation you are being exposed to. After a successful treatment, if the cancer comes back in the same place that the lymphoma first started, local relapse took place. It may also come back in another part of the body though. When HL relapses, it usually comes back the same way it was before. This means that a low-grade HL relapses as a low-grade lymphoma. But it is plausible for a low-grade to relapse as a high-grade. This is considered an aggressive type of HL and means the lymphoma has not responded well to treatment and is progressive. Widowed, sixty seven year old, Concepcion Salazar was a mother of seven and grandmother of ten. They were known to be a wholesome, united family that lived through most of their days in peace and harmony. It all changed for them during February of 2007 however. Suddenly life stopped and seemed like it would never be the same again. They were just told it was likely that their mother had cancer. Concepcion was known to be an optimist. She was religious to heart and very much believed in having faith and hoping for the best. But she couldn't deny the weight she was rapidly losing and the lumps growing all around her upper body, so it didn't take much for her to attend the follow-up of the original doctor's appointment that would lead to the news. The trouble was that she had been having problems for well over six months maybe a year, but all those problems could be put down to common ailments. No one ever believes something like cancer could happen to them. She had slightly swollen lymph nodes that weren't quite painful but uncomfortable. As for the weight, they figured she was still coping with her husband's passing from a few months before. During the follow-up appointment right after being sent off to Mexicali, Mexico for a blood test, Xray scan, and CT scan, the doctor right away appeared to know something was wrong. The Salazar family says she was amazing and gave them all the information they needed warmly confirming the news, all while trying to put everyone's mind at ease. They were told it was Hodgkin's Lymphoma, but to their luck it was highly treatable. The fact that they have been told the odds were in their favor was actually an amazing thing. This gave them a positive outlook on such an ugly situation which is really the best outlook and attitude anyone could have during cancer. She had a PET scan, to see where the exact location of cancer was and if it had spread and a biopsy to remove a couple of visible lymph nodes. This was accomplished by a small operation and a surgeon. On the fifteenth of March, they were given a proper prognosis and told she had Stage 2 of Hodgkin's Lymphoma. Treatment would consist of 6 months of chemotherapy. This was a twelve session treatment, which is essentially six four hour sessions of ABVD chemo every fourteen days. Depending on how it went, they said she might need radiotherapy after. Patricia, Concepcion's oldest daughter, says the appointment with the final results of the first treatment plan was the worst off them all. â€Å"It's a hit-or-miss, anticipated event where you're given all the facts and told all the things you never want to hear† She says it was when they first realized how much of a toll those six months had taken on all of the family. â€Å"You're overwhelmed by it all and just hoping that after this appointment, it will all be over† But of course, Concepcion never once showed any signs of distress or admitted the emotional turmoil amongst them, she realized she was sick but was quite stubborn! She never once complained about the pain, lethargy, loss of hair, never once refused to eat. In her mind she wasn't a victim of cancer, cancer was a victim of her! She was put into a two week steroid course with the purpose of strengthening her before the chemotherapy sessions started. They said it was a drag of a process, but to Concepcion's luck she always had one of her many family members keeping her company. The Salazar family happily look back and say they always tried to keep a positive ambience by trying to make hospital days, not just about the hospital. They'd go back home and have family gatherings and food, a solid family support system is one of the best medicines, they say. Concepcion had an interesting philosophy, when people asked her how she managed to always seem rather healthy and high on energy her response was always â€Å"the chemo experience is my experience, if I convince myself that I'll feel ill, I will† to everyone's surprise, she had no sickness or pain at all during her chemo. In fact, they hardly had to spend money on strong anti-sickness/pain medications. In the early days of the sickness everyone thought their lives had stopped, but they came to find out they still had their all-smiles mother that still interacted with her grandkids, prayed, made small-talk with random strangers. She was a beam of light to this world. Concepcion passed away on April 15th, 2008. About less than a month before, Mexicali experienced a 7.2 earthquake. Because of this, machinery used for checkups weren't working properly, and they missed her next appointment that would detect the cancer rapidly spreading. It had spread to her spinal and cerebral fluid, and she passed away in her sleep. In spite of her passing, Concepcion's story will always be an inspirational one. A positive attitude and support system goes a long way. Remember, we aren't victims of cancer, it's the other way around. Concepcion was lucky to have the people she cared about with her, but sometimes, even when you're with your loved ones, you might feel misunderstood and alone. People may miss the support they got from their health care team. This might be because many people have a sense that their safety net has been pulled away. It's important to actively look for emotional support in different ways. It could help you to talk to other people have or have had cancer, or to join a support group. Or, you may feel better talking to a counselor, church member, close friend, family member. There aren't a lot of support groups in my area, but there are in more prominent areas. There are also plenty online resources. Don't be afraid to seek for what it is you need. Cancer An essay or paragraph about their charity what it means to them, why it was chosen, or whatever they would care to say on the subject. Teens and Seniors at least 75 words. Helping people stay well, helping people get well, by finding cures, and by fighting back I have lost many 72%- program services: cancer research, [patient support, detection/treatment, prevention 28%- general, fundraising, advertising fight against cancer Cancer is classically defined as the uncontrolled growth of abnormal cells In the body. But, is feels like so much more than that to anyone who has experienced its sign of terror.To me cancer is defined as. Cancer goes far beyond sickness. I have lost many family members to different kinds of cancer such as heart, lung, bone marrow, and colon. I sometimes wonder if there was some way It could have been prevented. That is why my studio's charity of choice is the American Cancer Society or ACS. The ACS is dedicated to researching, treating, and preventing cancer In people all around the world. When a donation Is made to ACS 72% of the money Is put towards program services such as cancer research, patient support, detection/ treatment, and prevention.ACS devotes themselves to understanding cancer's causes, determining the best way to prevent It, and discovering new ways to cure It. Cancer produces malignant tumors which Invade, compress, and eventually destroy healthy tissue. Drinking excess alcohol, excessive sunlight exposure, smoking, and obesity are some of the bad habits we practice. Cancer can be detected early using different apparatus and tests like MR.. Scan, CT scan, Complete Blood Count (CB) and Biopsy. The earlier we detect cancer, the lesser symptoms we'll experience and the chance to cure this disease before It spread all over our body.

Persuasive Essay On Rape - 962 Words

I do. Two simple words that can completely change your life. Two words that you say when you are about to devote your life to someone. You promise to give them all your love, respect, care and trust. However, when you finally say those two final words you plan on it being to someone who adores you with every ounce of their body and soul, who would take a shot for you, someone who will be your hero. That is all you want someone to say â€Å"I do† back to you and make every promise you are making to them to you. However, after those final words are said you begin to see some flaws like over time your and your love begins to deteriorate. He starts to hurt you, hold you down, manipulate you, and you give in because it is your husband the man you†¦show more content†¦On July 5, 1993, marital rape became a crime in all 50 states in the US under one section of the sexual offense codes. Eventually, the District of Columbia made no exemption in 20 states for marital rape in Ma y, 2005. However, 30 states in the District of Columbia still have some exemptions for marital rape. Although many countries are reaching the knowledge of knowing there is something wrong with it, India has no laws against and It is even worse there. Each victim experiences higher levels of physical injury and longer lasting trauma. Wives are reported to be raped several more times in comparison to stranger rape. 16% of the wives that are raped by their significant other report it to the police (â€Å"Recognize Non Consensual Sexual Acts and How You Can Get Support†). There are reasons that women do not go to the police about the situation and that is their husband manipulates her into thinking she is not loving him or a god wife or that he is going to take the kids and leave. Some women are drugged as well by there husband so they will presume sex while they are unconcious. Being threatened, forced or just giving in are other ways of how a significant other can rape you (â⠂¬Å"Marital Rape†). However, there are people out there who believe that you can not be raped while married. Although, rape is defined as â€Å"unlawful sexual activity and usually sexual intercourse carried out forcibly or under threat ofShow MoreRelatedPersuasive Essay On Rape744 Words   |  3 PagesTherapists say the worst thing a survivor of rape can do is to remain silent, bottling their story up inside so it sinks like lead into their stomach. But, how do you find the words to possibly convey what has happened? How can there be words for such a feeling as losing your sanctity of self? I have many titles I have gained or earned over the years: college graduate, daughter, writer, dancer. But I am also a survivor of rape. Dancing used to be my sanctuary, whatever I could not place into wordsRead MorePersuasive Essay On Rape1023 Words   |  5 Pagesâ€Å"Sorry ma’am there just isn’t enough to bring this case to court† a statement that millions of victims of sexual assault, and rape must hear from the justice system. They must live the rest of their lives knowing two truths; first being that they were sexually assaulted and or raped, and the second truth being that the assailant was set free and may victimize more people. It is difficult to believe that even in modern times that this is happening, yet the truth of the matter is that these victimsRead MorePersuasive Essay On Rape1292 Words   |  6 PagesRape also known as sexual assault is having sexual intercourse or any form of sexual penetration against a person’s will or consent. It could be carried out by coercion, the use of physical power or abuse of authority. It is an act many societies, if not all discourage, and attracts different form of punishment in different geographical locations. There are many consequences of rape; some people suffer from depression, Post-Traumatic Stress Disorder, Suicidal tendencies, and Anxiety Disorder. ItRead MorePersuasive Essay On Rape1081 Words   |  5 Pagesor raped.† This is the all too common issue women go through in their minds, trying to block out the events that are occurring with them. Rape is an extreme issue, affecting over 280,000 Americans each year (RAINN). In numerous cases of rape, alcohol plays a factor in the sexual assault, either altering a victim or the perpetrator. The idea of alcohol and rape has become a controversial topic in society and court, determining the outcome of sexual assault cases. Because of this, the use of alcoholRead MorePersuasive Essay On Rape1456 Words   |  6 Pagesridic uled at an alarming rate. Many students have become increasingly fearful when attending their daily classes. Rape and date rape are serious problems that can lead to possible traumatization, depression, and suicide. Women are the main target of this kind of abuse, but men have also been known to suffer. Colleges have implemented new programs to help educate students about the risks of date rape, but they lack in their effectiveness to keep the students interested. Most of the courses are mandatory toRead MoreA Closer Look at Date Rape944 Words   |  4 Pagesin her essay â€Å"Rape: A Bigger Danger than Feminists Know.† The â€Å"them† in Paglia’s statement is referring to women, and she is discussing the topic of date rape. Susan Jacoby, on the other hand, writes in her article â€Å"Common Decency,† that feminism is not responsible for the rising cases of date rape, but that it is the men who are at fault. Paglia’s argument is insightful and acc urate, but Jacoby’s writing is flawed and not well-researched. Paglia includes all rhetorical appeals and persuasive techniquesRead MoreA Defense Of Abortion, By Judith Thomson And John Noonan990 Words   |  4 Pagesand John Noonan. Thomson makes many valid analogies in support of abortion in comparison to Noonan who just refutes basic arguments for abortion, and it is for this reason that Thomson is more persuasive. While Thomson makes many different analogies in his essay â€Å"A Defense of Abortion†, none were as persuasive as the famous violinist analogy. In the analogy, Thomas paints the picture of someone being kidnapped and their kidneys being used to support the life of the violinist. Thomson uses this argumentRead MoreThe Importance Of Writing781 Words   |  4 PagesAll throughout my public school education, the majority of my writing consisted of persuasive essays. While I have grown to become confident in my ability to produce this type of writing, when I started college, I felt lost writing research papers. The steps to writing a persuasive essay is so ingrained in my mind that it was hard to break out of that habit when my assignments required a different method. The only significant research paper that I wrote was during junior year of highschool. HoweverRead MoreWomen s Movement During The 1970 S1275 Words   |  6 PagesLiterature Essay During the waves of feminism many influential and significant movements that depicted the representation of women in a patronizing way. Whether it began in the 1970’s or the 1990’s these decades both held its own on the matters of oppression and the exploitation of women. Rape culture as well as women’s clothing options were twisted into making these decades some of the most influential for women of all times. From the way women were dressed, to celebrities standing out, rape cultureRead MorePersuasive Essay Topics1228 Words   |  5 Pages101 Persuasive Essay Topics By: Mr. Morton Whether you are a student in need of a persuasive essay topic, or a teacher looking to assign a persuasive essay, this list of 101 persuasive essay topics should be a great resource. I taxed my brain to create this huge list of persuasive essay topics relevant to todays society, but I believe I am happy with the results. I appreciate any and all comments or feedback. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24

The Need for Revenge Hamlet and The Butcher Boy - 1132 Words

Revenge is considered by many, sought by some, and carried out by few. It consumes the avenger and what is left is madness. The theme of revenge is depicted in many works of literature. Two great examples of this theme would be The Butcher Boy by Patrick McCabe and Hamlet, Prince of Denmark by William Shakespeare. In Shakespeare’s play the character of Hamlet is looking to avenge the murder of his father King Hamlet and in McCabe’s novel the character of Francie Brady seeks for revenge for almost everything that has happened to him, from the death of his mother to the loss of Joe’s friendship. Often the question of whether revenge is justified arises. In Hamlet’s case I see revenge as being justifiable because his motivations are strong,†¦show more content†¦In comparison to Hamlets motivations for revenge in The Butcher Boy Francie seeks revenge for all that is wrong with his life, and he expresses all his anger towards the Nugent family, particu larly Mrs. Nugent, even though she was not the direct cause. After Mrs. Nugent verbally attacked Mrs. Brady, all of Fancie’s anger, frustration and disillusionment was pinpointed towards the Nugent family. He went after them with pure vengeance on his mind. She says, â€Å"What else would you expect from a house where the father’s never in, lying about in pubs from morning to night, he’s no better than a pig†¦ Pigs-sure the whole town knows that!† (4). Anything that happened from then on could somehow be traced back to them. The Nugent family seems almost perfect to him and part of him I believe wants that stability. Even in his fantasy world he imagines Phillip saying, â€Å"He wants to be one of us. He wants his name to be Francie Nugent. That’s what he’s wanted all along† (64). Perhaps another motive for revenge is that Francie feels anger towards the Nugent family because they are a representation of what he cannot have. In c ontrast to the Nugent his family is broken; his mother is constantly in and out of a mental hospital because she attempts to commit suicide and has an alcoholic father who abuses his mother, which is far from ideal. Despite feeling sympathetic towards Francie because he has gone through a lot, I do not believe his revenge wasShow MoreRelatedModern English Macbeth21221 Words   |  85 Pagesattempted a laugh. ‘Yes,’ he said. ‘As much as sparrows dismay eagles or hares lions. If I m completely honest I d say they were like overworked guns, their barrels exploding, as they lay into the enemy.’ He slipped to the ground. ‘I m weak, I need help.’ ‘You ve done well,’ said Duncan. He turned to an attendant. ‘Go, get him to a doctor.’ As the sentries carried the sergeant out another newcomer, even fresher from the battlefield, arrived. ‘It s the worthy Thane of Ross!’ said MalcolmRead MoreBhopal Gas Disaster84210 Words   |  337 Pagesbusiness in India. A shareholder resolution on the agenda for this year s annual meeting asserts that it would be respectful of human rights and, more importantly, also a good business decision for Dow to undertake new initiatives to address the needs of survivors. The resolution requests the company to produce a document listing the new initiatives by the management pertaining to the environmental, health and social concerns of the survivors of the gas leak at the Union Carbide plant. The shareholders

Depression Essay - 1448 Words

Depression Introduction Depression is a common illness most people are affected by. Every person has suffered through at least one depression episode if not more. Depression does not discriminate against age, ethnicity or gender. For some people, depression is so severe they feel like it’s not worth living. Other people feel generally miserable or unhappy without really knowing why. Definition Depression is a medical illness that involves the mind and body. It affects how you feel, think and behave. Depression can lead to a variety of emotional and physical problems (Mayo Clinic, 2011). When Depression occurs, it intervenes with daily activities and lacks the feeling of any sort of joy or happiness. It also comes between social†¦show more content†¦Causes of Depression Many things may lead to depression but according to the NIMH (2012), cutting-edge research has presented new opportunities for studying people with depression. Brain-imaging technologies, like magnetic resonance imaging (MRI), have shown that the brains of people with depression actually look different from those of people without depression. Also Emedicineheath (2012) noted, depression is â€Å"not caused by personal weakness and is not a character flaw. When people suffer from depression, chemicals in your brain called neurotransmitters are out of balance†. Many people believe it’s a combination of family genes and/or a stress related event. Reported by MayoClinic (2012) Depression is more common in people â€Å"whose biological family members also have this condition†. Depression may begin with a simple difficult situation or a very big stressful event such as lost a loved one, had a baby, recently divorced, been diagnosed with a long-term disease such as diabetes or heart disease. Experts in Emedicinehealth (2012) suggested sometimes even happy life events, such as a marriage or promotion, can trigger depression because of the stress that comes with change (para 4). Depression can also be caused by hormones. According to MayoClinic (2011) Changes in the bodys balance of hormones may be involved inShow MoreRelatedDepression : Depression And Depression927 Words   |  4 Pagesthe word Depression. Now that I am older I know not to use that term so loosely because depression is a disorder that is very serious. According to the Mayo Clinic Depression, also known as major depressive disorder is a mood disorder that causes a feeling of sadness and a loss of interest. Depression can cause physical problems because it affects how you think along with how you act. For example, you may not want to do activities that you normally would, due to this disorder. Depression does notRead MoreDepression And Sadness Of Depression1423 Words   |  6 PagesTaylor Neighbors Winters English 1301.91 11 November 2015 Depression and Sadness Imagine you are in the middle of a monumental ocean surrounded by heavy, crashing waves. (TS) The sky is black, and the water is cold. Suddenly, the current pulls you under and you forget how to swim. You are desperately gasping for air, fighting the current, but you continue to sink uncontrollably. You scream and with every ounce of the little breath left in your lungs, but nobody hears you; nobody saves you. Your bodyRead MoreDepression And Its Effects On Depression1490 Words   |  6 PagesIn popular culture depression has become a thing that is seemingly almost sought after. A lot of youth use depression to have an edge or some kind of thing that makes them different. I feel like this ideology invalidates people with real mental illness and diagnosed depression. I say this but have also fallen victim to this aesthetic or aura that a lot of people portray. Although hard to define, depression can basically be summed up to be the lack of hope or courage pertaining to your life. It causesRead MoreDepression And Depression In Wurtzel931 Words   |  4 Pagesher life while dealing with depression and its symptoms. Having depression at a young age had affected her whole life and has made it difficult to act normal. Wurtzel expresses her sadness and copes in destructive ways such as cutting and doing drugs. The book goes on a journey of her life and the issues she goes through, meeting people, and dealing with additional problems. The novel’s main conflict is battling with depression and the urges of dealing with depression. I believe young readers wouldRead MoreDepression And Its Effects On Adolescent Depression1290 Words   |  6 PagesDepression is an issue facing a large amount of people today. It has becoming increasingly known that a lot of depression begins to start in the adolescent years for many individuals. The social work profession is critical in helping this adolescent depression not lead to further depression in adulthood. To understand adolescent depression and what is needed to help people suffering from it, we need to further understand the prevalence of adolescent depression, the effects it has on teens sociallyRead MoreDepression1008 Words   |  5 PagesDepression Teresa Collick HCA/250 April 24, 2016 Depression has always been a major health issue going back for many years. Initially being called â€Å"melancholia† it appeared in the texts of the Mesopotamians in the second millennium. It was then thought of a demonic presence that required a priest to be in attendance. The understanding was that depression wasn’t considered a physical issue but a spiritual or mental illness. The BabylonianRead MoreThe Effects Of Depression And Its Effects On Depression1642 Words   |  7 Pages Depression, 2 Every single day, across the entire world, people are diagnosed with clinical depression. I think a lot of people tend to see depression as a excuse/reasoning for something they ve done. In reality, there have been many discussions done and research studies completed on depression to see whether or not it is genetically passed down or learned through experiences/influences. I think it is safe to say that both genetic and environmental factors play a role in depression. InRead MoreA Brief Note On Depression And The Depression2842 Words   |  12 Pages Robyn Lawhorn July 11, 2015 Psychology 100 Mrs. Fischer Hours Worked: 22 Major depression, also known as unipolar depression, is one of the most common mental illnesses. Over nine million adults each year suffer from depression. Many people don’t understand what depression really is, including myself until I did a lot of research over this subject. Major depression is more than a temporary state of being sad. It is a persistent state that can significantly impair an individual’s thoughtsRead MoreDepression Essay : The Causes And Effects Of Youth Depression1566 Words   |  7 PagesCauses and Effects of Youth Depression Most individuals spend a short downcasted period in their lives, but some individuals experience an extended period of dejection. This may be the cause of depression. Depression is a mental disorder that feeds on the negative self-evaluation of an individual. Eventually the individual is blinded of any positivity in their life by the overwhelming pessimistic views of a situation, continuing the cycle. Awareness of adult depression is substantial, but unprogressiveRead MoreAdolescent Depression1112 Words   |  5 PagesDepression is a disease that afflicts the human psyche in such a way that the afflicted tends to act and react abnormally toward others and themselves. Therefore it comes to no surprise to discover that adolescent depression is strongly linked to teen suicide. Adolescent suicide is now responsible for more deaths in youths aged 15 to 19 than cardiovascular disease or cancer (Blackman, 1995). Despite this increased suicide rate, depression in this age group is greatly underdiagnosed and leads to serious

Infection Control & Hospital Epidemiology- myassignmenthelp.com

Question: Discuss about theInfection Control Hospital Epidemiology. Answer: Introduction Nursing plays a significant role when it comes to control of and management of infections. Nursing is assumed to the practice that forms a fundamental ground which helps to prevent as well as controlling the transmission of diseases that are infectious within the health care environment and its surrounding. Therefore, this paper discusses the important issues that should be taken care of by health workers to minimize the spread of diseases among the patients, workers or even the family members of the patient. Importance of Considering Infection Control in Nursing Mr. Reginald Bowen must be taken care of so to help reduce the spread of norovirus in the meantime. The symptoms such as severe abdominal pain, lethargy, headache, inability to urinate, diarrhoea and vomiting shown by Mr Bowen are also manifested by patient suffering from EVD illness that is highly fatal in human, severe and extremely contagious among people as well as animals. According to World Health organization, the average fatality rate of EVD is approximately 50% (Andertun et al., 2017 p. 648). Therefore, policies and precautions must be implemented to ensure that the spread of the deadly diseases is controlled. Policies like the engagement of the community members play a fundamental role in successfully preventing the outbreak of the fatal illness. Isolation of Mr Bowen and transferring him to safe areas also helps in preventing the spread of sickness (Team, 2106 p.1485). Additionally, excellent laboratory services, personal protective gears as well as social mobilizations assist in the control of the disease. Moreover, if the health workers and the staff show any signs and symptoms of the EVD such as vomiting, rash, muscle pain and diarrhea, they must be isolated from the rest of the group immediately and taken to a close safe room to minimize the spread of the disease (Lehmann et al., 2016 p.74). According to WHO, during diagnosis of Mr Bowen, the health workers as well as the staff must wear gloves, face masks that should be capable of repelling fluid and long sleeved gowns (Reidy et al., 2017 p. 46). Finally, routine cleanliness must be maintained through cleaning and disinfection of the equipment used when handling the patient. Identify two (2) important health issues/problems for your patient. Mr. Bowen being allergic to sulphur may suffered serious health complication because many hospital uses sulphur for various activities. Many hospital uses sulphur for various activities including preservation thereby posting a great health problem to Mr Bowen. Additionally, Mr Bowen also suffers from stress. This patient is stressed by the number of times and distance that his wife must cover so to come and see him. Stress can minimize Mr Reginald survival chances and lead to quick death as a result of the disease (McMahon et al., 2016 p. 135). Nursing Interventions used to address the Issues In case of inability to urinate, surgery can be done so must correct the problem that Mr Reginald Bowen is facing. Effective surgery can help him to urinate effectively and prevent emergence of other urethral diseases. Moreover, severe abdominal pain, lethargy, headache, diarrhoea and vomiting, careful and well-evaluated consideration should be given when handling the situation so as to enable the health workers determine and give correct prescription (Anderson et al., 2014 p.66. Necessity of using a particular Nursing Intervention in addressing the Issue: Mr Reginald Bowen should be put under careful observation including checking for Benign hypertrophic prostate (BHP), Gastro oesophageal reflux disease (GORD), the past infection that he has suffered from (Chipps et al., 2016 p.112). Consequently, immediate supportive and careful rehydration is very vital for the patient who suffers from internal as well as external bleeding to relieve them from muscle pain and fatigue. The interventions mentioned above are necessary because the patient had already indicated the symptoms. Additionally, the diagnosis mentioned above should be administered because the patient is already suffering from the impaired liver and kidney function as well as the internal and external bleeding (Kumar et al., 2017 p.232). Therefore, the methods mentioned above recommended since they speed up recovery thereby helping to reduce the pain. Conclusion Ebola virus Disease is known to be one of the most dangerous, contagious and fatal diseases around the world. The disease can quickly spread from one patient to another or from even animal and plants to human beings. One of the major symptoms of the illness is the external and internal bleeding from the infected persons. Due to high contagious nature of the disease, careful and sensible management measure should be put in place to ensure that the rate of its spread adequately minimized. Reference Anderson, D.J., Podgorny, K., Berros-Torres, S.I., Bratzler, D.W., Dellinger, E.P., Greene, L., Nyquist, A.C., Saiman, L., Yokoe, D.S., Maragakis, L.L. and Kaye, K.S., 2014. Strategies to prevent surgical site infections in acute care hospitals: 2014 update.Infection Control Hospital Epidemiology,35(S2), pp.S66-S88. Andertun, S., Hrnsten, . and Hajdarevic, S., 2017. Ebola virus disease: caring for patients in Sierra Leonea qualitative study.Journal of advanced nursing,73(3), pp.643-652. https://onlinelibrary.wiley.com/doi/10.1111/jan.13167/full Chipps, E.M., Carr, M., Kearney, R., MacDermott, J., Visger, T., Calvitti, K., Vermillion, B., Weber, M.L., Newton, C., Clair, J. and Harper, D., 2016. Outcomes of an oral care protocol in postmechanically ventilated patients.Worldviews on Evidence?Based Nursing,13(2), pp.102-111. Kumar, A., Unnikrishnan, B., Mithra, P., Kulkarni, V., Holla, R., Nazareth, S.V. and Bhat, V., 2017. Awareness Regarding Ebola Virus Disease among Health Care Professionals in Tertiary Hospitals.Indian Journal of Public Health Research Development,8(2). https://web.b.ebscohost.com/abstract?direct=trueprofile=ehostscope=siteauthtype=crawlerjrnl=09760245AN=122820270h=KDzmd9nmfFBlsdxi%2fv9c8zjtJJLYjBRyUMdKkCWm3hgb%2fWksLs5PgWeEyJmoEPfLYeT1E1w8P%2bPo6YIC7NfInA%3d%3dcrl=cresultNs=AdminWebAuthresultLocal=ErrCrlNotAuthcrlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d09760245%26AN%3d122820270 Lehmann, M., Bruenahl, C.A., Addo, M.M., Becker, S., Schmiedel, S., Lohse, A.W., Schramm, C. and Lwe, B., 2016. Acute Ebola virus disease patient treatment and health-related quality of life in health care professionals: A controlled study.Journal of psychosomatic research,83, pp.69-74. McMahon, Shannon A., Lara S. Ho, Hannah Brown, Laura Miller, Rashid Ansumana, and Caitlin E. Kennedy. "Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leones Ebola epidemic."Health policy and planning31, no. 9 (2016): 1232-1239 .https://academic.oup.com/heapol/article/31/9/1232/2452988/Healthcare-providers-on-the-frontlines-a Reidy, P., Fletcher, T., Shieber, C., Shallcross, J., Towler, H., Ping, M., Kenworthy, L., Silman, N. and Aarons, E., 2017. Personal protective equipment solution for UK military medical personnel working in an Ebola virus disease treatment unit in Sierra Leone.Journal of Hospital Infection,96(1), pp.42-48. https://www.sciencedirect.com/science/article/pii/S0195670117301494 Team, W.E.R., 2014. Ebola virus disease in West Africathe first 9 months of the epidemic and forward projections.N Engl J Med,2014(371), pp.1481-1495. https://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=article