How the Dow Jones Industrial Average Is Calculated

How the Dow Jones Industrial Average Is Calculated On the off chance that you read the paper, tune in to the radio, or watch the evening news on TV, you have likely caught wind of what occurred in the market today. Its all fine and great that the Dow Jones wrapped up 35 focuses to close at 8738, yet what does that truly mean? What Isâ the Dow? The Dow Jones Industrial Average (DJI), usually just alluded to as basically The Dow, is a normal of the cost of 30 unique stocks. The stocks speak to 30 of the biggest and most broadly traded on an open market stocks in the United States. The list gauges how these organizations stocks have exchanged throughout a standard exchanging meeting the financial exchange. It is the second-most established and one of the most referenced financial exchange record in the United States. The Dow Jones Corporation, the heads of the list, adjusts the stocks being followed in the list occasionally to best mirror the biggest and most broadly exchanged supplies of the day. The Stocks of the Dow Jones Industrial Average As of April 2019, the accompanying 30 stocks were constituents of the Dow Jones Industrial Average list: Organization Image Industry 3M MMM Aggregate American Express AXP Purchaser Finance Apple AAPL Purchaser Electronics Boeing BA Aviation and Defense Caterpillar Feline Development and Mining Equipment Chevron CVX Oil and Gas Cisco Systems CSCO PC Networking Coca-Cola KO Drinks Dow Inc. DOW Concoction Industry ExxonMobil XOM Oil and Gas Goldman Sachs GS Banking and Financial Services The Home Depot HD Home Improvement Retailer IBM IBM PCs and Technology Intel INTC Semiconductors Johnson JNJ Pharmaceuticals JPMorgan Chase JPM Banking McDonald's MCD Inexpensive Food Merck MRK Pharmaceuticals Microsoft MSFT Purchaser Electronics Nike NKE Clothing Pfizer PFE Pharmaceuticals Procter Gamble PG Purchaser Goods Voyagers TRV Protection UnitedHealth Group UNH Overseen Healthcare Joined Technologies UTX Aggregate Verizon VZ Media transmission Visa V Customer Banking Walmart WMT Retail Walgreens Boots Alliance WBA Retail Walt Disney DIS Broadcasting and Entertainment How the Dow Is Calculated The Dow Jones Industrial Average is cost arrived at the midpoint of implying that it is processed by taking the normal cost of the 30 stocks that contain the list and isolating that figure by a number called the divisor. The divisor is there to consider stock parts and mergers which additionally makes the Dow a scaled normal. On the off chance that the Dow werent determined as a scaled normal, the record would diminish at whatever point a stock split occurred. To represent this, assume a stock on the list worth $100 parts is part or isolated into two stocks every value $50. On the off chance that the executives didn't consider that there are twice the same number of offers in that organization as in the past, the DJI would be $50 lower than before the stock split since one offer is currently worth $50 rather than $100. The Dow Divisor The divisor is controlled by loads set on all the stocks (because of these mergers and acquisitions) and therefore, it changes frequently. For instance, on November 22, 2002, the divisor was equivalent to 0.14585278, however as of September 22, 2015, the divisor is equivalent to 0.14967727343149.â This means in the event that you took the normal expense of every one of these 30 stocks on September 22, 2015, and separated this number by the divisor 0.14967727343149, youd get the end estimation of the DJI on that date, which was 16330.47. You can likewise utilize this divisor to perceive how an individual stock impacts the normal. As a result of the equation utilized by the Dow, a one point increment or abatement by any stock will have a similar impact, which isn't the situation for all records. Dow Jones Industrial Average Summary So the Dow Jones number you hear on the news every night is basically this weighted normal of stock costs. Along these lines, the Dow Jones Industrial Average should simply be viewed as a cost in itself. At the point when you hear that the Dow Jones went up 35 focuses, it just implies that to purchase these stocks (considering the divisor) at 4:00 p.m. EST that day (the end time of the market), it would have cost $35 more than it would have cost to purchase the stocks the day preceding simultaneously.

Deception Point Page 41 Free Essays

Making the furious waterway of air significantly additionally startling to Tolland was the slight downwind grade of the ice rack. The ice was slanted marginally toward the sea, two miles away. In spite of the sharp spikes on the Pitbull Rapido crampons connected to his boots, Tolland had the uncomfortable inclination that any stumble may leave him got up to speed in a storm and sliding down the unending frigid slant. We will compose a custom article test on Trickiness Point Page 41 or on the other hand any comparable subject just for you Request Now Norah Mangor’s two-minute course in ice sheet security presently appeared to be perilously deficient. Piranha Ice hatchet, Norah had stated, securing a lightweight T-formed instrument to every one of their belts as they prepared in the habisphere. Standard cutting edge, banana edge, semitubular sharp edge, sledge, and adze. All you have to recollect is, in the event that anybody slips or becomes involved with a blast, snatch your hatchet with one hand on the head and one on the pole, slam the banana cutting edge into the ice, and fall on it, planting your crampons. With those expressions of affirmation, Norah Mangor had joined YAK belay bridles to every one of them. They all wore goggles, and took off into the evening haziness. Presently, the four figures advanced down the icy mass in an orderly fashion with ten yards of belay rope isolating every one of them. Norah was in the number one spot position, trailed by Corky, at that point Rachel, and Tolland as stay. As they moved more distant away from the habisphere, Tolland felt a developing anxiety. In his swelled suit, albeit warm, he felt like a clumsy space explorer trekking over a far off planet. The moon had vanished behind thick, surging tempest mists, diving the ice sheet into an invulnerable darkness. The katabatic breeze appeared to get more grounded continuously, applying a consistent strain to Tolland’s back. As his eyes stressed through his goggles to make out the sweeping vacancy around them, he started to see a genuine threat in this spot. Excess NASA wellbeing precautionary measures or not, Tolland was astonished the executive had been happy to chance four lives around here rather than two. Particularly when the extra two lives were that of a senator’s little girl and a renowned astrophysicist. Tolland was not astonished to feel a defensive worry for Rachel and Corky. As somebody who had captained a boat, he was accustomed to feeling answerable for everyone around him. â€Å"Stay behind me,† Norah yelled, her voice gulped by the breeze. â€Å"Let the sled lead the way.† The aluminum sled on which Norah was moving her testing gear took after a larger than average Flexible Flyer. The art was prepacked with analytic rigging and wellbeing embellishments she’d been utilizing on the ice sheet in the course of recent days. Every last bit of her rigging including a battery pack, wellbeing flares, and an incredible front-mounted spotlight-was bound under a made sure about, plastic covering. Regardless of the overwhelming burden, the sled skimmed easily on long, straight sprinters. Indeed, even on the practically vague slope, the sled moved downhill voluntarily, and Norah applied a delicate limitation, as though permitting the sled to lead the way. Detecting the separation developing between the gathering and the habisphere, Tolland investigated his shoulder. Just fifty yards away, the pale arch of the vault had everything except vanished in the tempestuous darkness. â€Å"You at all stressed over finding our direction back?† Tolland hollered. â€Å"The habisphere is nearly invisi-† His words were stopped by the boisterous murmur of a flare lighting in Norah’s hand. The abrupt red-white gleam lit up the ice rack in a ten-yard range surrounding them. Norah utilized her heel to dive a little impression in the surface day off, up a defensive edge on the upwind side of the opening. At that point she slammed the flare into the space. â€Å"High-tech bread crumbs,† Norah yelled. â€Å"Bread crumbs?† Rachel asked, protecting her eyes from the abrupt light. â€Å"Hansel and Gretel,† Norah yelled. â€Å"These flares will most recent 60 minutes a lot of time to discover our direction back.† With that, Norah took off once more, driving them down the ice sheet into the obscurity indeed. 47 Gabrielle Ashe raged out of Marjorie Tench’s office and for all intents and purposes thumped over a secretary in doing as such. Embarrassed, all Gabrielle could see were the photos pictures arms and legs entwined. Countenances loaded up with joy. Gabrielle had no clue how the photographs had been taken, however she realized damn well they were genuine. They had been taken in Senator Sexton’s office and appeared to have been shot from above as though by concealed camera. Lord have mercy on me. One of the photographs demonstrated Gabrielle and Sexton having intercourse legitimately on the senator’s work area, their bodies spread over a dissipate of authentic looking reports. Marjorie Tench found Gabrielle outside the Map Room. Tench was conveying the red envelope of photographs. â€Å"I expect from your response that you accept these photographs are authentic?† The President’s senior counsel really appeared as though she was making some acceptable memories. â€Å"I’m trusting they convince you that our other information is precise too. They originated from the equivalent source.† Gabrielle felt her whole body flushing as she walked a few doors down. Where the damnation is the exit? Tench’s bumbling legs experienced no difficulty keeping up. â€Å"Senator Sexton vowed to the world that both of you are dispassionate partners. His broadcast explanation was entirely convincing.† Tench motioned egotistically behind her. â€Å"In reality, I have a tape in my office if you’d like to invigorate your memory?† Gabrielle required no boost. She recalled the question and answer session very well. Sexton’s forswearing was as determined as it was ardent. â€Å"It’s unfortunate,† Tench stated, sounding not in the slightest degree baffled, â€Å"but Senator Sexton looked at the American individuals in the eye and told an unabashed deception. General society has an option to know. What's more, they will know. I’ll make sure by and by. The main inquiry currently is the means by which the open discovers. We accept it’s best originating from you.† Gabrielle was shocked. â€Å"You truly think I’m going to help lynch my own candidate?† Tench’s face solidified. â€Å"I am attempting to take the high ground here, Gabrielle. I’m allowing you to spare everybody a ton of humiliation by holding your head high and coming clean. All I need is a marked explanation conceding your affair.† Gabrielle held back. â€Å"What!† â€Å"Of course. A marked proclamation gives us the influence we have to manage the representative unobtrusively, saving the nation this appalling chaos. My offer is basic: Sign an announcement for me, and these photographs never need to see the light of day.† â€Å"You need a statement?† â€Å"Technically, I would require an affirmation, however we have a public accountant here in the structure who could-â€Å" â€Å"You’re crazy.† Gabrielle was strolling once more. Tench remained next to her, sounding increasingly furious at this point. â€Å"Senator Sexton is going down somehow, Gabrielle, and I’m offering you an opportunity to escape this without seeing your own stripped ass in the first part of the day paper! The President is a better than average man and doesn’t need these photographs advanced. On the off chance that you simply give me an affirmation and admit to the issue on your own terms, at that point we all can hold a little dignity.† â€Å"I’m not for sale.† â€Å"Well, your competitor positively is. He’s a risky man, and he’s breaking the law.† â€Å"He’s violating the law? You’re the ones breaking into workplaces and taking unlawful observation pictures! Have you ever known about Watergate?† â€Å"We had nothing to do with social event this soil. These photographs originated from a similar source as the SFF crusade subsidizing data. Someone’s been watching both of you very closely.† Gabrielle tore past the security work area where she had gotten her security identification. She ripped off the identification and hurled it to the wide-looked at watch. Tench was still on her tail. â€Å"You’ll need to choose quick, Ms. Ashe,† Tench said as they approached the exit. â€Å"Either present to me an affirmation conceding you laid down with the representative, or at eight o’clock this evening, the president will be compelled to open up to the world about everything-Sexton’s monetary dealings, the photographs of you, the works. What's more, trust me, when the open sees that you sat around and let Sexton lie about your relationship, you’ll go down on fire directly next to him.† Step by step instructions to refer to Deception Point Page 41, Essay models

Know Money, Win Money! Episode 16 Chicago Auto Show

Know Money, Win Money! Episode 16 Chicago Auto Show Know Money, Win Money! Episode 16:  Chicago Auto Show Know Money, Win Money! Episode 16:  Chicago Auto ShowVroom! Vroom! Honk! Get out of the way or get in the car, because we’re on our way to the newest episode of Know Money, Win Money. Yes, we went to the Chicago Auto Show for our latest quiz-em-up.Although they still didn’t have any flying cars, there was a car dressed up to look like an X-Wing from Star Wars, so well take what we can get. Did the attendees have a trunk full of car knowledge, or were they running on empty?Owning a car can be very pricey. Every piece seems to be as expensive as diamonds to replace, without being nearly as indestructibileâ€"hence the need for replacing. Gas can be expensive too, as can car-washes, detailing, and even air fresheners, depending on the scent.But how much does it cost in a year, on average, to own a car? Quite a bit. $8,500, in fact. You could  could certainly  find a used car for much cheaper than that. Well, not necessarily a functioning used car, mind you, but it would definitely be a metal box of some sort, and it would come with at least three wheels.  Either way, it’s enough to make you fall in love with public transportation.Given how much it costs to own a car, one would hope that a majority of American households would find a way to go without an automobile. One would be hoping in vain, howeverWe next  asked what percentage of American households have cars, and the answer is: a lot. Turns out that a whopping 95 percent of American households have a car. Yowzers!Maybe we should grind up some of those cars to build public transportation that stretches from the densest of cities to the most rural of mountain tops. Then again, Mad Max: Fury Road wouldnt really work if all the characters had to  take the bus, so there are pros and cons on both sides.That’s all for now! We’ve gotta  hit the road and get working on the next episode of Know Money, Win Money.If this is your first time  watching Know Money, Win Money, welcome! Here are some other recent epi sodes you can check out:Episode 15: Con Alt Delete (Part 2)Episode 14: Winter BrewfestEpisode 13: Con Alt DeleteWhere would you like to see us go in future episodes? We want to hear from you! You can  email us, or you can find us on  Facebook  and  Twitter

Impacts of Ocean Warming and Acidification on Coral Reefs - Free Essay Example

Sample details Pages: 2 Words: 609 Downloads: 8 Date added: 2019/03/14 Category Ecology Essay Level High school Tags: Global Warming Essay Did you like this example? For many decades, ecosystems in the world have experienced climate changes. These changes include sea levels rising, the increase of temperature, and widespread coral bleaching. Climate change is the change in temperature of our earth that is caused by human activity. Don’t waste time! Our writers will create an original "Impacts of Ocean Warming and Acidification on Coral Reefs" essay for you Create order One of these climate change catastrophes is ocean warming and acidification on coral reefs. Coral reefs are Anthozoa invertebrates of the phylum Cnidaria, made up of calcium carbonate skeletons. Coral reefs range from thousands of different species, making them a unique part of the marine world. Corals reef create symbiotic relationships with other organisms by providing shelter, food, and protection for several organisms even though they risk their own life. Corals are found in tropical islands, surrounded by clear waters which are susceptible to strong tropical storms (Hodgson et al. 560). It is best for coral reefs to be near the sand shore to receive sunlight to make photosynthesis. This allows corals to grow, as well as avoid strong water movements (Hodgson et al. 560). Coral reefs are rich with nutrients, which makes them a vital ecosystem. A vital ecosystem is a system that contains benefits to other environments. These benefits include ecological and economic benefits. Some economic benefits are commercial fisheries, tourism, and protection of shorelines. Commercial fisheries examples reside in Hawaii, an island that benefits from coral reefs due to food security, primary and secondary consumers, and cultural practices. Hawaiian fisheries provide the land $10.3 to $16.4 million annually, which is then broken down into commercial sales (Grafeld et al. 2017). An ecological benefit with tourism industries resides in the Maldives. In the Maldives, tourism is highly attracted due to its beautiful beaches which contain coral reefs. At least one million tourists are received in the Maldives, which gives them an increase in gross domestic products annually. With ecological benefits, coral reefs produce final coral sand and protect shorelines from wave energy and erosion. (Reguero et al. 147). The ocean acidification in coral reefs is caused by carbon dioxide that dissolves in water, products of human activity and release of carbon dioxide in the atmosphe re. PH levels are affected, which changes their environment since they require a certain amount of pH for the ecosystem to function. If the pH levels are not met, corals run out of zooxanthellae algae that provide oxygen (Manzello et al. 521). This affects the growth of coral reefs since too much of the pH levels in the water will cause a strong acidity, making the corals vulnerable to growth. Carbon dioxide also causes ocean warming. Ocean warming negatively impacts coral reefs since heat pressure consumed by the coral reefs result in a release of the zooxanthellae algae (Carilli et al. 2012). When the algae is released, the color of the coral reef changes known as coral bleaching. If greenhouse gas effects were not associated with the carbon dioxide in the atmosphere, the earth’s atmosphere would not accelerate global warming as it is today. Most global warming issues can be avoided if every individual was determined to make a change. Some of the steps that we can contribute to saving our planet are to use LED light bulbs for our home, reduce the excessive amount of food containing meats, maintaining your car tires, and reduce the excessive use of water. These steps help our surrounding maintain healthy, as well as respect nature for what it is. Even though this may be difficult to always think about in our daily routines, small changes in behavior can make a huge difference during our lifetime. As for coral reefs, it is best to recycle and pick up trash during beach vacations so that we do not add more stress to their environment.

Barbie s Role Models Represent The Unobtainable Physique

Growing up, I played with Barbie. Barbie had her own house, car and airplane. She had clothes and shoes for every occasion. She was independent and successful. She was tall, blonde and beautiful. She was everything I hoped to be as an adult. Barbie continues to be a role model for many little girls today. Little boys have their own role model, G.I. Joe. He is strong, a warrior, the good guy. Unfortunately, these iconic role models represent the unobtainable physique. Their body shapes are unrealistic. Perceiving these toys as physical role models has become detrimental to the health of children because when they fail to size up, or down, to these figures, serious illnesses, disease and even death can occur. Children are†¦show more content†¦However, these measurements are based upon a woman with a height of 6’1†. When I was a child, some 40 years ago, the average height of a woman was approximately 5’3.5†, as determined by the Centers f or Disease Control and Prevention (CDC). That average height has not changed much through the decades. Today, it is approximately 5’4† (Ogden, 10). It should be noted, the average weight for a woman with a height of 5’4† ranges from 115 to 140 pounds, well above Barbie’s weight of 100 pounds at 6’1†. The average weight for a woman of Barbie’s height of 6’1† ranges from 145 to 190 pounds. Table 1. Barbie doll Real Life Measurements Barbie doll real life measurements Type of doll Modern Vintage Body shape: Super-skinny type of hourglass (explanation) Dress size: 0 0 Breasts-Waist-Hips: 32-22-33†³ (81-56-84cm) 35-22-32†³ (89-56-81cm) Bra size: 30B 32C Cup size: B C Height: 6’1†³ (185 cm) 6’1†³ (185 cm) Weight: Both about 100 lbs (45 kg) Natural breasts or implants? Could be natural (how do we know this?) Source: Barbie doll. Body Measurements. The South Shore Eating Disorders Collaborative (SSEDC), through the National Eating Disorder Association (NEDA), contradicted these findings and created the Get Real Barbie campaign based upon the writings of Margo Maine, Ph.D. They utilized Barbie’s measurements and related them to a human woman. Based upon a height of 5’9†, which is still well above the average, Barbie would have a waist of 18†,

Case Study †Appendicitis Free Essays

I. DEFINITION/PREVALENCE Acute disease of the GI tract may be caused by the pathogen itself or by a bacterial or other toxin. Acute inflammatory disorders such as appendicitis and peritonitis result from contamination of damaged or normally sterile tissue by a client’s own endogenous or resident bacteria (Lemone and Burke, 2008, page 766). We will write a custom essay sample on Case Study – Appendicitis or any similar topic only for you Order Now Appendicitis is the inflammation of the vermiform (wormlike) appendix; the appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve, which is the beginning of the large intestine. It is usually located in the right iliac region, at an area designated as McBurney’s point. McBurney’s point, located midway between the umbilicus and the anterior iliac crest in the right lower quadrant. It is the usual site for localized pain and rebound tenderness due to appendicitis during later stages of appendicitis. The function of the appendix is not fully understood, although it regularly fills and empties digested food. Some scientists have recently proposed that the appendix may harbor and protect  bacteria  that are beneficial in the function of the human colon. Appendicitis  is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. The lower quadrant pain is usually accompanied by a low-grade fever, nausea, and often vomiting. Loss of appetite is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burney’s point applied located at halfway between the umbilicus and the anterior spine of the Ilium. Rebound tenderness (ex. Production or intensification of pain when pressure is released) may be present. The extent of tenderness and muscle spasm and the existence of the constipation or diarrhea depend not so much on the severity of the appendiceal infection as on the location of the appendix. If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. Rovsing’s sign may be elicited by palpating the left lower quadrant. If the appendix has ruptured, the pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patient’s condition worsens. The disease is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates. It is the most common reason for emergency abdominal surgery, affecting 10% of the population. Although appendicitis affects a person at any age, the peak incidence is between the ages of 20 and 30 years old in which the vast majority of clients are most common in adolescents and young and slightly more common in males than females. About 7% of the population will have appendicitis at some time in their lives (Lemone and Burke, 2008 page 766). The major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal Pyle phlebitis, which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines. Perforation generally occurs 24 hours after the onset of pain symptoms include a fever of 37. 7 degree Celsius or 100 degree Fahrenheit or greater, a toxic appearance and continued abdominal pain or tenderness. II. TYPES/CLASSIFICATION Appendicitis can be classified as simple, gangrenous, or perforated, depending on the stage of the process. In simple appendicitis, the appendix is inflamed but intact. When areas of tissue necrosis and microscopic perforations are present in the appendix, the disorder is called gangrenous appendicitis. A perforated appendix shows evidence of gross perforation and contamination of the peritoneal cavity (LeMone Burke, 2008 page 766). Peritonitis can be primary or secondary. Primary peritonitis is an acute bacterial infection that is not associated with perforated viscus, or organ. Bacterial infection is the usual cause and may be associated with an infection by the same organism somewhere else in the body, which reaches the peritoneum via the vascular system. Tuberculosis peritonitis, which originates from tuberculosis elsewhere in the body, is a type of primary peritonitis. Clients with alcoholic cirrhosis and ascites, in the absence of a perforated organ, often manifest peritonitis, which may be due to leakage of bacteria through the wall of the intestine. Secondary peritonitis is usually caused by bacterial invasion as a result of perforation, or rupture of an abdominal viscus. It can also result from severe chemical reactions to: pancreatic enzymes, digestive juices, or biles released into the peritoneal cavity (Gould Dyer, 2011). III. DEMOGRAPHIC PROFILE Patient’s name is Mr. Ruptured Acute Appendicitis, 24 years old, male, residing at 820 General Kalentong, Daang Bakal, Mandaluyong City. He is the second child among 3 siblings, a Roman Catholic, single, a 3rd year college Information Technology student. IV. FAMILY MEDICAL HISTORY (Family Genogram)COD: TB COD: TB A: 83 -S, -D A: 83 -S, -D Not Recalled Not Recalled c c A: 20 +S, +D A: 20 S, +D A: 24 +S, +D A: 24 +S, +D A: 27 -S, -D Skin allergy A: 27 -S, -D Skin allergy A: 42 +S, +D A: 42 +S, +D A: 64 +S, +D HPN, Stroke A: 64 +S, +D HPN, Stroke c c A: 46 -S, +D Asthma A: 46 -S, +D Asthma A: 51 -S, +D A: 51 -S, +D patient patient LEGEND: LEGEND: male male married married deceased male deceased male S- smoker D- drinker COD- cause of death S- smoker D- drinker COD- cause of death female female deceas ed female deceased female V. PAST MEDICAL HISTORY He was first hospitalized last 2006 due to dengue at the same hospital: Mandaluyong City Medical Center (MCMC). He has no other further illnesses except the typical fever, cough and cold. Other than that, he has no allergies, hypertension, or diabetes mellitus. VI. HISTORY OF PRESENT ILLNESS 1 week prior to admission patient experienced abdominal pain all over abdomen. He consulted at ER MCMC signed out AUPD (Acute Peptic Ulcer Disease) and was given Omeprazole HNBB (Buscopan). Whole abdominal ultrasound done and revealed tiny cholecystolethiasis. He was given Diclofenal and HNBB tab and eventually discharged. Few days prior to consultation, the patient still experienced abdominal pain. He consulted at Emergency Room and was opted for surgical intervention – EXPLORATORY LAPAROTOMY APPENDECTOMY under the service of Dr. Abram Del Valle, M. D. VII. GORDON’S PHYSICAL ASSESSMENT i. Health Maintenance – Perception Pattern Before admission: The patient used to smoke cigarette 3 sticks per day. And he also drinks alcohol daily specifically beer of more than 2 bottles per session. He was not using drugs and he has no allergies at all. During time of care: The patient is not smoking cigarette or drinking alcohol. ii. Nutritional – Metabolic Pattern Before admission: The patient was on a high protein diet because he was used to go to the gym 2-3 times a week. He was also taking vitamins (CENTRUM). He has normal appetite and has no difficulty swallowing. He usually eats 3 times a day (breakfast, lunch and dinner) and most of the time he also has his snacks. He also usually drinks 2-3 liters of water a day. e During time of care: The patient is on NPO (nothing per orem) for 5 days due to post-operative appendectomy and he was on his 2nd day of NPO status when we cared for him. He has also NGT lavage connected. ii. Elimination Pattern Before admission: The patient’s normal bowel movement was 3 BM a day and has no difficulty in bladder habits. His last bowel movement was last July 17, 2012. He usually urinates 6-7 times a day without difficulty. During time of care: The patient has absence of bowel movement and even flatus and has no bowel sounds upon auscultation. He has foley catheter and with urine output of 480 cc per shi ft. iv. Activity and Exercise Before admission: The patient could do his activities independently without assistance. He usually goes to gym 2-3 times a week. During time of care: The patient’s functional level or self-care ability level is 2 which mean he requires help from another person for assistance. v. Sleep/Rest Pattern Before admission: The patient usually sleeps at 4 or 5 am and wakes up at 8 or 9 am. He has no difficulty in sleeping and he feels rested after sleep. During time of care: The patient has regular sleeping habits. He sleeps at 10 am, wakes up at 6 am with uninterrupted sleep. vi. Cognitive – Perceptual Pattern Before admission: The patient was alert and coherent, has normal speech, with mild level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. During time of care: The patient is alert and coherent. He has normal speech (Filipino as his spoken language), he has moderate level of anxiety, has normal hearing, and with impaired vision of his left eye due to cataract. He also complained of acute pain and described it as a cramping pain. Pain management (Tramadol) was given. vii. Role – Relationship Pattern Before admission: The patient was a student and single. His support system was his family, relatives friends. During time of care: The patient’s support system is his mother who is always at his bed side assisting him in whatever he needs. Upon asking his mother if she has any concerns regarding hospitalization, she said that she is more concern about the fast recovery of her son. viii. Sexuality – Reproductive System Before admission and during the time of care: The patient still didn’t have his testicular exam. ix. Coping – Stress Tolerance/Self – Perception/Self – Concept Pattern The patient’s major concern regarding his hospitalization is s all about self-care. Due to the contraptions attached to him, he cannot independently do his activities. His major loss was his stepfather when he died of kidney failure. His rated his outlook on future as 5, 1 being poor and 10 being very optimistic. He further explained why he rated 5 because he is not sure if when he finished college he can be able to find a job suited for him. x. Value – Belief Pattern Our patient is a Roman Catholic and he always goes to church every Sunday together with his family. VIII. GROWTH AND DEVELOPMENT DEVELOPMENTAL TASK| THEORIST| STATUS| Intimacy vs. Isolation * Develops commitments to others and to a life work (career)(Daniels, et. al. , 2010). | Erikson| The patient had a relationship with his opposite sex but he said that they just broke up a week before he was hospitalized due to some personal and private reasons. Currently, he is in 3rd year college, an IT student. | Genital * Emergence of sexual interests and development of relationships with potential sexual partners (Daniels, et. al. , 2010). | Freud| As what had written above, the patient had a relationship with his opposite sex but because of some reasons they decided to end up their relationship. Formal Operations * Able to see relationships and to reason in the abstract (Daniels, et. al. , 2010). | Piaget| He perceived that relationships (any kind of relationship) are important especially at his age. He can also reason out in an abstract way. He can express his opinions intellectually and precisely. | Early Adulthood * Select a partner, learn to live with a partner, s tart a family, manage a home, establish self in a career/occupation, assume civic responsibility, and become a part of a social group (Daniels, et. al. , 2010). Havighurst| According to our patient, he didn’t expected that something like that will happen to them (referring to his girlfriend). He was really expecting that they are really meant for each other and that she (his gf) will be his future wife. He is also establishing himself to a future career, that’s why he is studying in preparation for his future. During our time of care also, his ‘barkadas’ visited him and he said that they were his ‘tropa’. | Postconventional * Individual understands the morality of having democratically established laws (Daniels, et. al. , 2010). Kohlberg| Upon asking the patient if he is familiar with the democratically established laws in the Philippines, he immediately responded with a yes. He also said that these laws help us, Filipinos, to have safe and se cure country though there may come a time that we may experience something unexpectedly. | IX. PHYSICAL ASSESSMENT * Vital Signs TIME| Initial 8AM (07/24/12)| 10 AM| 12 NN| 8 AM (07/25/12)| 12 NN| Last 8AM(07/26/12)| T| 36. 3| 37. 3| 37. 4| 36. 4| 37. 3| 36| P| 83| 84| 71| 75| 81| 68| R| 23| 25| 21| 19| 19| 20| BP| 120/80| 120/80| 120/80| 120/80| 120/80| 110/80| Sequence: BY SYSTEMS NORMAL FINDINGS| BOOK FINDINGS| PATIENT FINDINGS| SIGNIFICANCE| I. NEUROLOCIGAL SYSTEM Alert and coherent; with normal body temperature of 36. 3 °C – 37. 6 °C| * Fever (usually 38 °C although hypothermia may be present w/ severe sepsis); chills * Thirst * Pain| * Complained of pain in the incision site (lower longitudinal midline of the abdomen)| Pain results from the increased pressure of fluid on the nerves, especially in enclosed areas, and by the local irritation of nerves by chemical mediators such as bradykinins (Gould, et al. 2011). | II. RESPIRATORY Normal respiration with a rate of 12-20 breaths per minute| * Tachypnea; shallow respirations| * RR: 23 bpm w/ shallow respiration| Acute pain usually initiates physiologic stress response with increased respiratory rate (Gould Dyer, 2011). | III. INTEGUMENTARY Pink or brown and in uniform color, no edema, no lesions, moistSkin temperature is normally warmIntact skinWhen pinched, skin springs back to previous state| * Dry lips and mucous membranes * Swollen tongue * Poor skin turgor| * Dry lips and mucous membranes * Skin turgor:3-5 seconds * Presence of surgical incision at lower longitudinal midline of the abdomen * Skin is warm to touch and is reddened| Dry mucous membrane and poor skin turgor are signs of dehydration (Gulanick, et al. 1994). Redness may indicate inflammation (Weber Kelly, 2007). Redness and warmth are caused by increased blood flow into the damaged area (Gould Dyer, 2011). | IV. CARDIOVASCULAR Normal pulse rate of 60-100 bpm| * Tachycardia * Diaphoresis * Pallor * Hypotension * Tissue edema| * Pulse rate: 83 bpm| Acute pain usually initiates a physiologic stress response with increased heart rate (Gould Dyer, 2011). | V. MUSCOLOSKELETAL Ability to do Activities of Daily Living (ADL)| * Difficulty ambulating * Weakness| * Difficulty ambulating due to post-op condition * Weakness| Constant pain frequently affects daily activities and may become a primary focus in the life of an individual (Gould Dyer, 2011). | VI. GENITO-URINARY Normal urine output of 30cc/hrColor: Amber, transparent, clear| * Decreased urinary output * Dark color urine| * Dark color urine * Urine output: 480 mL/shift * Specific gravity: 1. 30| Decreasing output of concentrated urine with increasing specific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). | VII. GASTROINTESTINAL Abdominal skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elementsAbdomen is free of lesions or rashesA series of intermittent, soft clicks and gurgles are heard at a rate of 5-30 per minuteNormally no tenderness or pain is elicited or reported by the clientNo rebound tenderness is presentAbdo men is non-tender and soft. There is no guarding| * Loss of appetite * Nausea vomiting(usually projectile) * Constipation of recent onset * Diarrhea(occasional) * Sudden, severe, generalized abdominal pain * Abdominal distention; rigidity * Decreased/absence of bowel sounds * Inability to pass stool/flatus * Muscle guarding (abdomen) * Psoas’ Sign (flexion of or pain on hyperextension of the hip due to contact between an inflammatory process the psoas muscle) * Obturator Sign (the internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee and a resultant tightening of the internal obturator muscle may ause abdominal discomfort) * Rovsing’s Sign (pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant) * Rebound tenderness (a sign of inflammation of the peritoneum in which pain is elicited by the sudden release of the fingertips pressing on the abdomen) | * Board-like abdomen * Sudden, severe, generalized abdominal pain * Absence of bowel sounds in all four quadrants * Absence of flatus/stool * Presence of surgical incision| Signs indicating the onset of peritonitis include a rigid â€Å"board-like† abdomen (Gould Dyer, 2011). Pain recurs as a steady, severe abdominal pain as peritonitis develops (Gould Dyer, 2011). Absence of bowel sounds may be associated with peritonitis or paralytic ileus (Weber Kelly, 2007). When inflammation persists, nerve conduction is impaired, and peristalsis decreases, leading to obstruction of the intestines (paralytic ileus) (Gould Dyer, 2011). | X. DIAGNOSTIC TESTS DIAGNOSTIC TEST| NORMAL| RESULT| SIGNIFICANCE| WHOLE ABDOMINAL ULTRASOUND (July 21, 2012) | The organs examined appear normal (Cosgrove, et al. , 2008). | Liver is not enlarged. It has homogenous echopattern with smooth border. The intrahepatic ducts are not dilated. No evident focal mass lesion seen. CD measures 3. 9mm. Gallbladder is normal in size and wall thickness. There are multiple tiny echogenic shadowing foci seen within the gallbladder lumen. Pancreas spleen are normal in size echopattern. No focal mass lesion seen. Both kidneys are normal in size echopattern. Right kidney measures 10. 1Ãâ€"4. 2Ãâ€"5. 46cm with cortical thickness of 1. 7cm while the left kidney measures 10. 5Ãâ€"4. 8Ãâ€"4. 1cm with thickness of 19cm. No evident caliectasis, lithiasis, seen bilaterally. Urinary bladder is unfilled. Impression:Tiny cholecystolithiasesNormal liver, pancreas, spleen, kidneys by UTZUnfilled urinary bladderNot dilated biliary tree | Abdominal ultrasound is the most effective test for diagnosing acute appendicitis (LeMone Burke, 2007). | HEMATOLOGY REPORT/COUNT (July 21, 2012)| RBC: 4. 2-5. 6 M/uLPlatelets: 150-400 x 10/LWBC: 3. 8-11. 0 K/mm3Hemoglobin: 135-180g/LHematocrit: 0. 45-0. 52DifferentialNeutrophils: 0. 50-0. 81Lymphocytes: 0. 14-0. 44Monocytes:0. 02-0. 06Eosinophils: 0. 01-0. 05Basophils:0. 00-0. 01| WBC Count: 12. 6 K/mm3RBC: 4. 1 M/uL (normal)Hematocrit: 0. 45 (normal)Hemoglobin: 153g/L (normal)Differential Count:Neutrophils 0. 90Lymphocytes 0. 10 (normal)| Elevated WBC is seen in acute infection (LeMone Burke, 2007). Neutrophils: elevated in bacterial infection (LeMone Burke, 2007). | URINALYSIS (July 21, 2012)| Color: Light straw to amber yellowAppearance: ClearOdor: AromaticpH: 4. 5-8. 0Specific gravity: 1. 005-1. 030Protein: 2-8mg/dLGl ucose: NegativeKetones: NegativeRBCs: RareWBCs: 3-4Casts: Occasional hyaline| Color: Dark YellowTransparency: TurbidUrine pH: 6. 0 Specific gravity: 1. 30Sugar: NegativeProtein: +4Microscopic examPus cells 4-6/HPFRBC 1-2/HPFCrystals: Amorphous Sulfate Moderate| A dark yellow to brownish color is seen with deficient fluid volume (LeMone Burke, 2007). Hazy or cloudy urine indicates bacteria, pus, RBCs, WBCs, phosphates, prostatic fluid spermatozoa, or urates (LeMone Burke, 2007). | CLINICAL CHEMISTRY (July 21, 2012)| Sodium (Na): 135-142 mmol/LPotassium (K): 3. 8-5 mmol/L| Sodium: 132 mmol/LPotassium: 4. 02 mmol/L| Sodium is decreased in SIADH vomiting (LeMone Burke, 2007). | XI. ANATOMY PHYSIOLOGY OF APPENDIX (LARGE INTESTINE) The large intestine, which is about 1. 5 m (5 ft) long and 6. 5 cm (2. 5 in. ) in diameter, extends from the ileum to the anus. It is attached to the posterior abdominal wall by its mesocolon, which is a double layer of peritoneum. Structurally, the four major regions of the large intestine are the cecum, colon, rectum, and anal canal. The opening from the ileum into the large intestine is guarded by a fold of mucous membrane called the ileocecal sphincter (valve), which allows materials from the small intestine to pass into the large intestine. Hanging inferior to the ileocecal valve is the cecum, a small pouch about 6 cm (2. 4 in. ) long. Attached to the cecum is a twisted, coiled tube, measuring about 8 cm (3 in. ) in length, called the appendix or vermiform appendix (vermiform = worm-shaped; appendix = appendage). The mesentery of the appendix, called the mesoappendix, attaches the appendix to the inferior part of the mesentery of the ileum. The open end of the cecum merges with a long tube called colon, which is divided into ascending, transverse, descending colon are retroperitoneal; the transverse and sigmoid colon ascends on the right side of the abdomen, reaches the inferior surface of the liver, and turns abruptly to the left to form the right colic (hepatic) flexure. The colon continues across the abdomen to the left side as the transverse colon. It curves beneath the inferior end of the spleen on the left side as the left colic (splentic) flexure and passes inferiorly to the level of the iliac crest as the descending colon. The sigmoid colon begins near the left iliac crest, projects medially to the midline, and terminates as the rectum at about the level of the third sacral vertebra. The rectum, the last 20 cm (8 in. ) of the GI tract, lies anterior to the sacrum and coccyx. The terminal 2-3 cm (1 in. ) of the rectum is called the anal canal. The mucous membrane of the anal canal is arranged longitudinal folds called anal columns that contain a network of arteries and veins. The opening of the anal canal to the exterior, called the anus, is guarded by an internal anal sphincter of smooth muscle (involuntary) and an external anal sphincter of the skeletal muscle (voluntary). Normally these sphincters keep the anus closed except during the elimination of feces (Tortora Derrickson, 2006). XII. PATHOPHYSIOLOGY NARRATIVE Appendicitis, inflammation of the vermiform appendix, is a common cause of acute abdominal pain. It is the most common reason for emergency abdominal surgery, affecting 10% of the population (Tierney et al. , 2005). Appendicitis can occur at any age, but is more common in adolescents and young adults and slightly more common in males than females (LeMone Burke, 2007). The development of appendicitis usually follows a pattern that correlates with the clinical signs, although variations may occur because of the altered location of the appendix or underlying factors (Gould Dyer, 2011). Obstruction of the proximal lumen of the appendix is apparent in most acutely inflamed appendices. The obstruction is often caused by fecalith, or hard mass of feces. Other obstructive causes include a calculus or stone, a foreign body, inflammation, a tumor, parasites (e. g. , pinworms), or edema of lymphoid tissue (LeMone Burke, 2007). Following obstruction, the appendix becomes distended with fluid secreted by its mucosa and microorganisms proliferate. Pressure within the lumen of the appendix increases, impairing its blood supply because blood vessels in the wall are compressed thus the appendiceal wall becomes inflamed and purulent exudate forms. Within 24 to 36 hours, the increasing congestion and pressure within the appendix leads to ischemia and necrosis of the wall, resulting in increased permeability. Bacteria and toxins escape through the wall into the surrounding are. This breakout of bacteria leads to abscess formation or localized peritonitis. An abscess may develop when the adjacent omentum temporarily walls off the inflamed area by adhering to the appendiceal surface. In some cases, the inflammation and pain subside temporarily but then recur. Localized infection or peritonitis develops around the appendix and may spread along the peritoneal membranes. Increasing pressure inside the appendix causes increased necrosis and gangrene in the wall (infection in necrotic tissue). The wall of the appendix appears blackish. The appendix ruptures or perforates, releasing its contents into the peritoneal cavity. This leads to generalized peritonitis and would lead to septicemia and into septic shock and will result to death (Gould Dyer, 2011). XIII. PATHOPHYSIOLOGY DIAGRAM Risk Factors Non-modifiable: * Age (Adolescents young adults) * Gender (Male) Modifiable: * Fecalith * Calculus/Stone * Foreign body * Inflammation * Tumor * Parasites Edema of lymphoid tissue Obstruction of the appendiceal lumen Obstruction of the appendiceal lumen Buildup of fluid inside the appendix Buildup of fluid inside the appendix Proliferation of microorganisms Proliferation of microorganisms Abdominal pain Abdominal pain Increased pressure within the lumen of appendix Increased pressure within the lumen of appendix Compression of blood vessels Compression of blo od vessels * Fever * Obturator Sign * Psoas Sign * Rovsing’s Sign * Rebound tenderness * Fever * Obturator Sign * Psoas Sign * Rovsing’s Sign * Rebound tenderness Decreased blood flow into the appendix Decreased blood flow into the appendix Inflammation of appendiceal wall Inflammation of appendiceal wall (July 21, 2012) Hematology Count * WBC count: 12. 6 K/mm * Neutrophils: 0. 90 Urinalysis * Transparency: turbid (July 21, 2012) Hematology Count * WBC count: 12. 6 K/mm * Neutrophils: 0. 90 Urinalysis * Transparency: turbid Ischemia necrosis of the wall Ischemia necrosis of the wall Increased permeability Increased permeability Bacteria and toxins escape through the wall Bacteria and toxins escape through the wall Abscess formation/localized bacterial peritonitis Abscess formation/localized bacterial peritonitis Proliferation of localized peritonitis around the appendix and peritoneal membranes Proliferation of localized peritonitis around the appendix and peritoneal membranes Increased pressure inside the appendix Increased pressure inside the appendix * Sudden, severe, generalized abdominal pain * Abdominal distention rigid â€Å"boardlike† abdomen * Absence of bowel sounds/(-) flatus/(-) BM (July 24, 2012) * Sudden, severe, generalized abdominal pain * Abdominal distention rigid â€Å"boardlike† abdomen * Absence of bowel sounds/(-) flatus/(-) BM July 24, 2012) Increased necrosis and gangrene in the wall Increased necrosis and gangrene in the wall Appendectomy with NGT lavage (July 22, 2012) Appendectomy with NGT lavage (July 22, 2012) Perforation of the appendix Perforation of the appendix Intestinal bacteria leak out into peritoneal cavity Intestinal bacteria leak out into peritoneal cavity * Low-grade fever leukocytosis * Tachycardia * Hypotension * Vomiting * Low-grade fever leukocytosis * Tachycardia * Hypotension * Vomiting Generalized peritonitis Generalized peritonitis XIV. NURSING PROCESS Problem #1: ABDOMINAL PAIN – July 24, 2012 * Subjective Cues: * â€Å"Nurse wait lang, ang sakit kasi parang nagcacramps,† patient verbalized while having a conversation with him. How does it feel like: Abdominal cramping Precipitating factor: â€Å"Kapag nililinisan pero kadalasan bigla-bigla na lang sumasakit† (â€Å"Whenever wound cleaning is performed but oftentimes it just suddenly happened†) Relieving factor: Pain reliever (but not all the time pain reliever is being given) Does it radiate to the other parts of the body (back, legs, chest, etc): No Duration of pain: â€Å"Paiba-iba din eh. Minsan sobrang tagal mga 2-3 minutes, minsan naman mga ilang Segundo lang† (â€Å"It differs, sometimes it’s too long (2-3 minutes) and sometimes it just happened for a second†) * Patient rated the pain as 8/10 where 0 signifies no pain and 10 signifies unbearable pain. * Objective Cues: * Facial grimace * Guarding of the incision site * Rigid (board-like) abdomen * Abdominal distention * Location of pain: Surgical site * RR: 25 bpm * Nursing Diagnosis Acute Pain related to inflammation of the tissues secondary to post-op surgical incision. Inflammation or nerve damage gives rise to changes in sensory processing at peripheral and central level with a resultant sensitization. In relation, prostaglandins are chemotactic substances drawing leukocytes to the inflamed tissue. It plays a vasoactive role; it is also a pain and fever inducer (Lemone and Burke, 2007). Acute Pain related to infection inflammation of the peritoneal membranes secondary to peritonitis The peritoneum consists of a large sterile expanse of highly vascular tissue that covers the viscera and lines of abdominal cavity. This peritoneal structure provides a mean of rapid dissemination of irritants or bacteria throughout the abdominal cavity. Abdominal distention is evident, and the typical rigid, board-like abdomen develops as reflex abdominal muscle spasm occurs in response to involvement of the parietal peritoneum (Gould Dyer, 2011). * Goal/NOC: Pain Control Outcomes Short Term: After 30 minutes of nursing intervention the patient will report a decrease in pain from pain scale of 8/10 to 4-5/10. Long Term: After 8 hours of nursing intervention the patient will demonstrate an understanding about the proper way of controlling pain as evidenced by proper splinting and deep breathing exercise and will report a decrease or most probably will be free from pain from pain scale of 4-5/10 to 1-2/10. * NIC: Pain Management Independent: * Assessed pain including its character, location, severity, and duration. Both preoperatively and postoperatively, the client’s pain provides important clues about the diagnosis and possible complications. Abdominal distention and acute inflammation contribute to the pain associated with peritonitis. Surgery further disrupts abdominal muscles and other tissues, causing pain (LeMone Burke, 2007). * Monitored vital signs every 2 hours. Vital Signs, especially respiratory rate (RR), are usually altered in acute pain. (Sparks and Taylor, 2005). * Kept the client at rest in semi-Fowler’s position. Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position (Doenges et al. , 2006). * Provided diversional activities (texting, sound trip, etc). Refocuses attention, promotes relaxation, and may enhance coping abilities and diverts attention from pain (Doenges et al. , 2006). * Taught post-op health teaching (e. g. , proper splinting deep breathing exercises). The use of non-invasive pain relief measures can increase the release of endorphins and enhance the therapeutic effects of pain relief medications (LeMone Burke, 2007). * Encouraged early ambulation. Promotes normalization of organ function; stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). Give hot and cold compress. Hot, moist compresses have a penetrating effect. The warm rushes blood to the affected area to promote healing. Cold compresses may reduce total edema and promote some numbing, thereby promoting comfort. (Doenges et al. , 2006). Dependent: * Administered analgesic as prescribed (TRAMADOL 50 mg/IV Q 8 ° x 3 doses) Time given: 8 AM. Post-operatively, analgesics are provided to maintain comfort and enhan ce mobility (LeMone Burke, 2007). * Kept on NPO. Decreases discomfort of early intestinal peristalsis and gastric irritation/vomiting (Doenges et al. 2006). * Evaluation Short Term: Goal partially met. After 30 minutes of nursing intervention the patient reported of a decrease in pain from a pain scale of 8/10 to 6/10 in which 4-5/10 was the expected outcome. Long Term: Goal met. After 8 hours of nursing intervention the patient displayed control of pain as evidence by deep breathing exercise and proper splinting. He also reported of a decrease in pain with a pain scale of 2/10 from 6/10. Pain reliever – TRAMADOL was given @ 8 am via IV. Problem #2: ABSENCE OF FLATUS– July 24, 2012 * Subjective Cues: â€Å"Nurse wait lang, ang sakit kasi parang nagcacramps (referring to abdominal cramping),† patient verbalized while having a conversation with him. * Pain scale of 8/10 * Objective Cues: * (-) Flatulence * (-) BM (Last BM was July 17, 2012) * Absence of bowel sou nds upon auscultation of all four quadrants * Nursing Diagnosis Dysfunctional gastrointestinal motility related to inflammatory process of peritonitis secondary to absence of flatulence. The inflammatory process of peritonitis often draws large amounts of fluid into the abdominal cavity and the bowel. In addition, peristaltic activity of the bowel is slowed or halted by the inflammation, causing paralytic ileus, impaired propulsion of forward movement of bowel contents (LeMone Burke, 2007). * Goal/NOC: Ambulation Outcomes Short Term: After 8 hours of nursing intervention the client will report/experience flatus and will understand and demonstrate the need for early ambulation following abdominal surgery. Long Term: After 2 days of nursing intervention the client will report/experience either flatus or bowel movement or both. * NIC: Impaction Management; Positioning Independent: * Assessed abdomen including all four quadrants noting character to determine increased or decreased in motility; Assessed for further abdominal tenderness auscultated for any abdominal sounds. To help identify the cause of the alteration and guide development of nursing intervention (Sabol Carlson, 2007). * Monitored and recorded (intake) and output every hour or 2 hours. Intake and output records provide valuable information about fluid volume status (LeMone Burke, 2007). * Encouraged early ambulation. Promotes normalization of organ function; stimulates peristalsis and passing of flatus, reducing abdominal discomfort (Doenges, et al. , 2006). * Assisted in moving from side to side or up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. (Gulanick, et. al. , 1994). Dependent: * Administered antacid as ordered (RANITIDINE 50g/IV Q 12 °. Antacids either directly neutralize acidity, increasing the  pH, or reversibly reduce or block the secretion of acid by gastric cells to reduce acidity in the stomach (Gabriely, et al. 2008). * Evaluation Short Term: Goal partially met. After 8 hours of nursing intervention the patient didn’t experience flatus or even bowel movement but was able to have an understanding with regards to early ambulation as evidenced by letting his mother assist him in moving up in bed going to the chair but refused to walk because of complaint of ha ving a lot of contraptions attached to him which causes him to have difficulty in moving. Long Term: Goal met. After 3 days of nursing intervention the patient reported of a flatus for 3 times. Problem #3: RISK FOR DEHYDRATION – July 24, 2012 * Subjective Cue: * â€Å"Nanghihina na ako kasi limang araw ako hindi pwede kumain pati tubig bawal din kaya nagnunuyo na yung labi ko,† as verbalized by the patient. * Objective Cues: * NPO for 5 days * Dry mucous membrane * Dry lips * Capillary refill= 2 seconds * Skin turgor= 3-5 seconds * Urine output/shift= 480 mL * Urine color: Dark Yellow * Urine specific gravity: 1. 030 (Normal value: 1. 005-1. 030) * Absence of bowel sounds of all the four quadrants * (-) Flatus, (-) BM * BP: 120/80 mmHg * PP: 83 bpm * Nursing Diagnosis Risk for deficient fluid volume related to postoperative restriction secondary to NPO for 5 days Inflammation of the peritoneum with sequestration fluid and NPO status can lead to dehydration and electrolyte imbalance (Doenges, et al. , 2008). * Goal/NOC: Knowledge: Treatment Regimen; Hydration; Oral Hygiene; Tissue Integrity: Skin Mucous Membranes Outcomes Short Term: After 30 minutes of nursing intervention patient will have an understanding with regards to maintaining fluid balance as evidenced by willingness of following the prescribed regimen given by the medical staffs. Long Term: After 3 days of nursing intervention the patient will be able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor, stable vital signs, and individually adequate urine output. * NIC: Fluid Management; Fluid Monitoring; Vital Signs Monitoring Independent: * Monitored BP Pulse. Variations help identify fluctuating intravascular volumes, or changes in vital signs associated with immune response to inflammation (Doenges, et al. , 2006). * Inspected mucous membranes; assessed skin turgor and capillary refill. Indicators of adequacy of peripheral circulation and cellular hydration (Doenges, et al. 2006). * Monitored intake and output; noted urine color/concentration, specific gravity. Decreasing urine output of concentrated urine with increasing specific gravity suggests dehydration/need for increased fluids (Doenges, et al. , 2006). * Auscultated bowel sounds. Noted passing of flatus, bowel movement. Indicators of return of peristalsis, readiness to begin oral intake (Doenges, et al. , 2006). * Provide clear liquids in small amounts when oral intake is resumed, and progress diet is tolerated. Reduces risk of gastric irritation/vomiting to minimize fluid loss (Doenges, et al. 2006). * Stressed the importance of having him on a NPO status and provided the necessary information with regards to his condition and the medications being administered (e. g. , IVF). It provides the patient a full understanding with regards to his condition thus encouraging him to participate and work hand in hand with the staff (Gulanick, et al. , 1994). * Gave frequent mouth care with special attention to protection of the lips. Dehydration results in drying and painful cracking of the lips and mouth (Doenges, et al. , 2006). Dependent: * Maintained gastric suction as indicated. Although not frequently needed, an NG tube may be inserted preoperatively and maintained in immediate postoperatively phase to decompress the bowel, promote intestinal rest, and prevent vomiting (Doenges, et al. , 2006). * Administered IV fluids (D5LR 1L x 8 ° or 30 gtts/min) and electrolytes (D5 Balanced Multiple Maintenance Solution w/ 5% dextrose 1L x 8 ° or 30 gtts/min). The peritoneum reacts to irritation/infection by producing large amounts of intestinal fluid, possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances (Doenges, et al. , 2006). * Evaluation Short Term: Goal met. After 30 minutes of nursing intervention the patient was able to have a full understanding with regards to maintaining fluid balance as evidenced by verbalizing, â€Å"So kaya pala hindi pa ako pwede kumain ngaun para maiwasan mairritate ang tiyan ko. † Long Term: Goal met. After 3 days of nursing intervention the patient was able to maintain adequate fluid balance as evidenced by moist mucous membrane, good skin turgor (1-2 seconds), stable vital signs (please see page __ ), and adequate urine output of 620 mL with an appearance of amber yellow. Problem #4: RISK FOR INFECTION – July 24, 2012 Subjective Cues: â€Å"Nurse, sobrang kailangan ba talaga ang paghuhugas ng kamay bago linisan o hawakan sugat niya? †, asked by the mother. * Objective Cues: * Post-operative condition – presence of surgical incision * Surgical site is warm to touch and reddened * Temp: 36. 3 °C * Nursing Diagnosis Risk for infection related to inadequate prim ary defenses secondary to post-operative surgical incision It is risk to be invaded by pathogens especially if surgical site is near at the perineal area, pathogens can also develop by poor personal hygiene and poor wound cleaning (Doenges, et al. 2006). * Goal/NOC: Risk Control (For Infection) Outcomes Short Term: After 30 minutes of nursing intervention the patient will be able to have partial understanding about infection control and will verbalize understanding of and willingness to follow up prescribed regimen. Long Term: After 3 days of  nursing intervention  the  patient will be free of sign and symptom r/t infection. * NIC: Incision Site Care; Infection Control; Wound Care Independent: * Monitored vital signs. Noted onset of fever, chills, diaphoresis, changes in mentation, and reports of increasing abdominal pain. Suggestive of presence of infection/developing sepsis, abscess, peritonitis (Doenges, et al. , 2006). * Inspected incision and dressings. Noted characteristics of drainage from wound/drains, presence of erythema. Provides for early detection of developing infectious process, and/or monitors resolution of preexisting peritonitis (Doenges, et al. , 2006). * Instructed proper hand washing. Practiced aseptic wound care. Reduces risk for infection (Doenges, et al. , 2006). * Encouraged adequate nutritional intake after the NPO status of the patient and when the patient is allowed to eat. Adequate intake of protein, Vitamin C and minerals is essential to promote tissue and wound healing (Sparks and Taylor, 2005). Dependent: * Administered antibiotics (CEFUROXIME 750mg TID Q 8 ° x 2 doses METRONIDAZOLE 500g/IV Q 8 ° x 2 doses) as ordered. Therapeutic antibiotics are given if the appendix is ruptured or abscessed or peritonitis has developed (Doenges, et al. , 2006). * Prepare for/assist with incision and drainage (ID) if indicated. May be necessary to drain contents of localized abscess (Doenges, et al. , 2006). * Evaluation Short Term: Goal met. After 30 minutes of nursing intervention the patient was able to have an understanding about infection control as evidenced by verbalizing, â€Å"Para maiwasan ang pagkaroon ng impeksyon kailangan kong maghugas ng kamay palagi at kinakailangan din ang araw-araw na paglilinis ng sugat ko kahit na sa tuwing nililinisan ito makirot sa pakiramdam. † Long Term: Goal met. After 3 days of  nursing intervention  the  patient was free of sign and symptom r/t infection. Problem #5: INABILITY TO PERFORM ACTIVITY/IES OF DAILY LIVING (ADL) – JULY 24, 2012 * Subjective Cues: â€Å"Hirap talaga ako gumalaw, maglakadlakad, o kahit man lang umupo dahil sa mga nakakabit na ito sa akin,† as verbalized by the patient. â€Å"Nakakapanghina pa kasi masakit nga yung tahi tapos madalas din nagcacramps ang tiyan ko,† he added. * Objective Cues: * Presence of surgical incision * Presence of contraptions (urinary catheter, NGT lavage IV fluid @ left hand) * Nursing Diagnosis Impaired physical mobility related to body weakness, presence of surgical incision, pain, presence of contraptions attached Physical immobility can be usually associated with post-operative conditions (Gulanick, et al. 1994). * Goal/NOC: Activity Tolerance Outcomes Short Term: After 30-45 minutes of nursing intervention the patient will be able to have a clear understanding with the use of identified techniques to enhance activity tolerance and to apply it as well as evidenced by participating in ROM exercises, lower leg ankle exercise, ambulation, or even moving up in bed. Long Term: After 2-3 days of nursing intervention the patient will be able to continually participate in a simple form of activity and will report an improvement with regards to his activities. * NIC: Exercise Therapy: Balance Independent: * Performed passive ROM exercises. ROM exercises and good body mechanics strengthen abdominal muscles and flexors of spine (Gulanick, et al. , 1994). * Encouraged lower leg and ankle exercises. Evaluated for edema, erythema of lower extremities, and calf pain or tenderness. These exercises stimulate venous return, decrease venous stasis, and reduce risk of thrombus formation (Gulanick, et al. , 1994). * Noted emotional and behavioral responses to immobility. Provided diversional activities. Forced immobility may heighten restlessness and irritability. The Cardiovascular System iframe class="wp-embedded-content" sandbox="allow-scripts" security="restricted" style="position: absolute; clip: rect(1px, 1px, 1px, 1px);" src="https://phdessay.com/the-cardiovascular-system-intrinsic-conduction-system/embed/#?secret=fKNLnNlg3O" data-secret="fKNLnNlg3O" width="500" height="282" title="#8220;The Cardiovascular System#8221; #8212; Free Essays - PhDessay.com" frameborder="0" marginwidth="0" marginheight="0" scrolling="no"/iframe Diversional activity aids in refocusing attention and enhances coping with actual and perceived limitations (Gulanick, et al. , 1994). * Assisted with activity, progressive ambulation, and therapeutic exercises. Activity depends on individual situation. It should begin as early as possible and usually progresses slowly, based on client tolerance (Gulanick, et al. , 1994). * Assisted in moving from side to side or up in bed from time to time. Frequent repositioning helps in proper oxygenation and usually prevents complications like pressure ulcers, deep vein thrombosis, etc. Gulanick, et al. , 1994). * Noted client reports of weakness, fatigue, pain and difficulty accomplishing tasks. Symptoms may be result of/or contribute to intolerance of activity (Gulanick, et al. , 1994). Dependent: * Administered pain medication (TRAMADOL 50 mg/IV Q 8 ° x 3 doses, time given: 8 AM) as prescribed and on a regular schedule. Client’s anticipation of pain can increase muscle tension. Medica tions can help relax the client, enhance comfort, and improve motivation to increase activity (Gulanick, et al. , 1994). * Evaluation Short Term: Goal partially met. After 30-45 minutes of nursing intervention the patient was able to have a clear understanding with the use of identified techniques to enhance activity tolerance and was able to use all of the techniques except for the ambulation. He refused to walk because he complained of pain whenever the catheter tube slipped into his legs. Long Term: Goal partially met. After 2-3 days of nursing intervention the patient was able to continually participate in all of the identified techniques but still refused to participate in ambulation. He also reported of an improvement with regards to his activities as evidence by his verbalization, â€Å"Medyo natotolerate ko na rin yung mga activities kahit pautay-utay muna. Hindi ko lang talaga muna kaya maglakad pero pagnaalis na siguro yung catheter baka kayanin ko na. † XV. BIBLIOGRAPHY * Cosgrove DO, Meire HB, Lim A, Eckersley RJ. (2008). Grainger Allisonn’s Diagnostic Radiology: A Textbook of Medical Imaging (5th edition). New York, NY: Churchill Livingstone * Doenges M. , Moorhouse, M. ; Murr, A. (2006). Nursing Care Plans Guidelines for Individualizing Client Care across the Life Span (7th Edition). F. A. Davis Company, Philadelphia * Doenges, M. , Moorhouse, M. ; Murr, A. (2006). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th Edition). F. A. Davis Company, Philadelphia * Gabriely I, Leu, J. P. , Barky, N. (2008). Clinical problem-solving, back to basics. New England Journal of Medicine * Gould, B. ; Dyer, R. (2011). Pathophysiology for the Health Professions (4th Edition). Saunders Elsevier Inc. * Gulanick, M. Klopp, A. , Galanes, S. , Gradishar, D. ; Puzas, M. (1994). Nursing Care Plans Nursing Diagnosis and Intervention (3rd Edition). Mosby-Year Book, Inc. * LeMone P. ; Burke, K. (2007). Principles of Medical-Surgical Nursing: Critical Thinking in Client Care (4th Edition). Pearson International Edition * LeMone P. ; Burke, K. (2008). Principles of Medical-Surgical Nursing: Critical Thinking in Client Care (5th Edition). Pearson Internation al Edition * Mosby’s Pocket Dictionary of Medicine, Nursing ; Allied Heath (4th Edition) 2002, Mosby Inc. Palma G. ; Oseda A. (2009). G;A Notes Clinical Pocket Guide for Medical and Allied Health Professionals (2nd edition). G;A Notes Publishing Co. , Philippines * Sabol, V. K. ; Carlson, K. K. (2007). Diarrhea: Applying research to bedside practice. AACN Advanced Critical Care * Tortora G. ; Derrickson B. (2006). Principles of Anatomy and Physiology 11th edition. Biological Sciences Textbooks, Inc. * Weber J. ; Kelley J. (2007). Health Assessment in Nursing (3rd Edition). Lippincott Williams ; Wilkins How to cite Case Study – Appendicitis, Free Case study samples

Secret Crimes Of Compassion Essays - Euthanasia, Medical Ethics

Secret Crimes Of Compassion Secret Crimes of Compassion To please no one will I prescribe a deadly drug, nor give advice which may cause death. -Oath of Hippocrates This phrase alone supports the very battle cry of those who oppose euthanasia. Their efforts have gone as far as to help make laws forbidding doctor-assisted suicide, including strict procedures for medical staff to determine the competency of an ill patient. But then there are those who wish to make it easier on themselves and even the family and friends, and choose as alternative route the their suffering. Extremely difficult problems arise surrounding the issue of euthanasia: What is the difference between killing someone and letting someone die? Who determines the competency of a terminally ill patient? If a patient is incompetent, who then makes the decisions for him? Most importantly, do we even have the right to die? The question of whether this is a moral battle or a legal battle has yet to be determined. Ever though the issue of suicide may consist of both factors, if one commits suicide successfully, they live neither with the moral guilt nor the face the legal consequences . So then if a second party is involved, it changes the whole story. What is the difference between killing someone and letting someone die? To get a little more technical, these phrases are also known as active and passive euthanasia. If one were to evaluate both of these, he would probably say that letting someone die were a better choice than killing someone. After all, most medical practices in the U.S. allow for the legally. One may be preferred over the other but is that one better than the other? In an example, let's say that a doctor decides to withhold treatment of a patient who is to die in the next couple of days. He does this because he finds it helpless to prolong his suffering. But in actuality, when the doctor withdraws his treatment, the patient takes a lot longer to die and is in more agonizing pain. Once this decision is already made, speeding up his death through active euthanasia looks more preferable over passive euthanasia. So the point is that allowing someone to die may take longer and be more painful, where giving them a letha l injection might be quick and painless (Rachels, 428). Even in today's society, people think it is morally wrong to kill someone rather than letting someone die. But is it really worse? To help answer this question, there is another example that will help illustrate the issue. There was a guy named CJ who was to inherit a lot of money if anything were to happen to his three-year-old nephew. One day his nephew was swimming outside in the pool when CJ came along and drowned him and made it look like an accident. Then there was another guy named Joe who also was to inherit a lot of money if anything was to happen to three-year-old nephew. Well Joe, who decides to kill his nephew, went outside where his nephew was swimming in the pool. To Joe's surprise, he saw that his nephew had slipped, hit his head and fell face first into the water. Joe is excited and stands by to watch him drown and does nothing to save him. Did either one of these guys act any better than the other? If one were to look at it from a moral aspect, one would say that CJ' s actions were morally worse than Joe's because CJ actively killed his nephew. But both of these guys had the same intention, goal and personal gain from the incident. CJ may look like the terrible guy for his actions and Joe may be regarded as a sick individual for watching. But didn't Joe do something? Any way you look at it, these two men committed an act, whether it was passive or active, one is no better than the other. In medical practices today, doctors may not necessarily try to destruct their patients with the same intentions as CJ and Joe. But the possibilities of active and passive euthanasia may be because the doctor may find a patient's life of no use or it

Fashion In the 1920s essays

Fashion In the 1920s essays Fashion had a big impact on the culture of the 1920s and 30s. The styles were more based on comfort and having a fresh start after World War I. Womens clothes became tighter and more revealing. Mens were about being sophisticated at first but then laid back. This period in time was a completely new era. Fashion leading up to the 1920s The fashion of the 1900s was very different to those in following years. The fashion in the early 1900s was very sophisticated and elegant. The women commonly wore fitted bodiced dresses with petticoats and corsets under them. They usually were  ¾ length sleeves and were worn with gloves that covered up the bare arm that would have been showing. Lace and ruffles were very much in style and the details were very important. They usually were made out of linen and worn with a thick belt at the waistline. Men had a different sort of fashion as well. The men dressed fairly formal and proper for casual events. They usually wore 3 piece suits with suit jackets with no collar. This era in fashion was called the Edwardian Period. The fashion in this time was sophisticated, elegant, and chic. Womens Fashion in the 1920s Women dressed in all different ways in the 1920s. The women were all about having a new fresh start after the war. They wanted to look sassy and cute as apposed to the dull and boring styles of those leading up to it. Some new styles made a big impact on the parents of the 20s. Girls wanted to cut their hair, which was a very controversial statement at the time. Girls who dressed like this were called flappers. Being a flapper was commonly related to smoking and drinking. Although attempts were made to show what a flapper was really about. Ellen Welles Page wrote an article to Outlook magazine called A Flappers Appeal to Parents. She tried to convince the moms that being a ...

SAT Accommodations What They Are and How to Get Them

SAT Accommodations What They Are and How to Get Them SAT / ACT Prep Online Guides and Tips You can slow down the clock with SAT accommodations. If you have a documented disability, or are just curious about what it takes to get SAT extra time, you may be wondering about the process of getting SAT accommodations. We’ll take you through the process step-by-step, and show you how to maximize your odds of getting accommodations. If you’re taking the SAT and have a disability or other condition, you will want to read this guide! Overview of the Accommodations Process There are two ways to get accommodations on the SAT – either by requesting them through your school, or requesting them yourself using a paper application. College Board strongly encourages going through your school, since they allow school coordinators to use their online Services for Students with Disabilities (SSD) system. If you use the paper request system, it will take longer, plus you will have to provide much more documentation about the accommodations you need and the condition that you have. Even by going through your school – the fastest option – getting your accommodations can take up to seven weeks. That means if you want accommodations by a certain test date, you should begin the approval process well in advance. For some tests you may even have to begin getting your approval during the previous school year. For example, if you want to take the October SAT with accommodations, College Board recommends you begin the process the previous spring. Getting accommodations can be a long process, and will require lots of documentation. It should go without saying that you should only seek accommodations if you have a disability or condition that requires them. Typically, most students who get accommodations on the SAT are students with disabilities who also receive accommodations at school. Still, if you don’t receive accommodations at school but think you may need them for the SAT, read on to learn about the process and your odds of getting accommodated. The Three Basic Steps to Getting Testing Accommodations 1. Start the process early enough to make sure you have time – keeping in mind it takes seven weeks once your materials are submitted. Keep reading for a detailed timeline! 2. Send your request and documentation to College Board, either through your school’s SSD coordinator or via paper. (For more on documentation, types of accommodations, and conditions that are most commonly accommodated, see below.) 3. Once College Board approves your request, they will give you a seven-digit code. Use that code when signing up for the SAT online and your accommodations will automatically be included. What Kind of Disability or Condition Do I Need to Have to Qualify? To get approval of your accommodations by College Board, they need to verify you have a documented disability or condition that impairs your ability to take the SAT. For the SAT, students with disabilities like the following are often accommodated, though this is not an exhaustive list: ADHD Autism Spectrum Disorders Communication Disorders Head Injuries Hearing Impairments Learning Disorders Physical/Medical Disabilities Psychiatric Disorders Tic Disorders/Tourette’s Visual Impairments Note that limited English proficiency is not considered a condition that College Board can provide accommodations for. For the fine print on College Board’s eligibility standards, see their website. What If I Have a Temporary Condition? It’s not going to be easy to bubble in answers with a broken wrist†¦ If you have a temporary condition that is impairing your ability to take the SAT - for example you broke your right wrist and that’s your writing hand - it is possible to get accommodations, but it will be much more difficult. The odds increase if you are signed up for an AP Exam and will not heal by the late test date, or if you are a senior who hasn’t taken the SAT yet. The process will be different for you. Instead of working with your school’s SSD coordinator or sending in the Accommodations Approval form to College Board, you will submit a different form, which you can access online here. What Are Common Accommodations? The accommodations you can get will vary based on your needs and situation. Here are some of the most commonly given SAT accommodations: Extended time (50% extra is most common, anything more than 100% is considered rare) on either one section or the entire test Computer for typing essays Extra or extended breaks Reading/seeing accommodations (e.g. large print, Braille, magnifier) Scribe for essays Reader for the test Different setting – e.g. preferential seating, small group, or a private room For a more exhaustive list, see this College Board guide. As an example, a student with ADHD might take the test with a small group of students to minimize distractions. Or a student with a learning disability in math might receive extended time on the math sections. Or a student with diabetes might request frequent breaks to be able to track their blood sugar during the test. There are many different potential combinations of condition and accommodation, and they will change based on your particular situation. Extended time, extra or extended breaks, computers, and reading/seeing accommodations are among the most common, though there is a much longer list of potential accommodations. (The College Board provides a more exhaustive list including rarer accommodations like special time of day and special lighting.) If you need an accommodation not listed, College Board encourages you to submit your request anyway for approval. Timing to Request SAT Accommodations Get ready to plan ahead. Make sure to begin the process of seeking accommodations early. The approval process can take up to seven weeks, and only begins once College Board has received all of your documentation. If some of your documentation is missing and/or you have to resubmit information, the seven-week process will begin all over again. Since preparing documentation and getting all of your information to College Board will take some time, even if you are working through your school, make sure you begin with plenty of time to spare – at least three months before your desired test date to be safe. College Board recommends the following timeline to receiving documentation: 2016-17 Test Date Deadline for College Board Receiving Documentation October 1, 2016 SAT August 12, 2016 October 15 and 19, and November 2, 2016 PSAT/NMSQT August 30, 2016 November 5, 2016 SAT September 16, 2016 December 3, 2016 SAT October 15, 2016 January 21, 2017 SAT December 2, 2016 February 21-March 31, 2017, PSAT 10 December 16, 2016 March 11, 2017 SAT January 20, 2017 April 3-14 , 2017, PSAT 10 February 13, 2017 May 1-5, 8-12, 2017, AP Exams February 17, 2017 May 6, 2017 March 17, 2017 June 3, 2017 April 14, 2017 Timeline via College Board. Obviously, many of these test dates and deadlines have already passed, but you can use these dates to plan ahead – for example, if you are planning on taking the SAT in October of your junior year, know that you should have all documentation submitted by late August of your junior year. Also, note that for the October tests, since the deadline for materials being received is in late August – when most school years start – you should begin the process of reaching out to your school’s SSD Coordinator and getting documentation the previous Spring. The first week of school is a hectic time, so you'll likely not be able to get it done then. In fact, to be safe, it’s not a bad idea to have your materials submitted by June so just in case something is missing, you will have time to get everything sent over the summer so there will be plenty of time to approve your request before the October test. So How Do I Apply for SAT Accommodations? Method 1 (Highly Recommended): Go Through Your School College Board recommends, and we agree, the most efficient way to get accommodations is to go through your school. Specifically, contact your school’s Services for Students with Disabilities (SSD) coordinator. If you’re not sure who that is, contact someone at your school’s guidance counseling department and they will be able to direct you. Your school’s SSD coordinator will be able to use College Board’s SSD Online service, which is a more streamlined accommodations approval service. In fact, it’s likely your school’s SSD coordinator has already been through this process with other students, so they will be familiar with College Board’s SSD system and will be able to help guide you through the process. The SSD coordinator will provide you with a parent consent form, which you need to get signed by your parents/guardians and returned to the school before the process can begin. Next, the SSD coordinator will sign up for SSD Online, and submit documentation related to your request, including your IEP (Individualized Education Plan) or 504 Plan if you have one. (If your school’s SSD coordinator is new to the process, direct them to this link for College Board’s instructions.) In other words, your SSD coordinator will handle most of the process, including making the request and providing necessary documentation. In most cases, this means your family does not have to provide additional documentation. However, you may need to provide extra documentation if any of the following scenarios apply: 1. You are not on an IEP or 504 Plan, or have one but haven’t been using it for at least the last four months, or haven’t been receiving any accommodations for at least four months. Basically, if you haven’t been receiving accommodations at school, College Board will want to know why you need them for the SAT. 2. Your school does not have documentation that meets College Board guidelines. 3. Your disability testing is not current. 4. You’re requesting an uncommon accommodation like more than 100% extended time. College Board will want to make sure that, when granting exceptional accommodations, you actually need them. After your SSD Coordinator submits your request, College Board will send back an approval or denial within seven weeks. One benefit of the SSD Online system is that, if College Board requires extra documentation or something is missing, they will be able to immediately alert your school’s SSD coordinator, which will speed up the process. Method 2: Submit a Paper Request If you can’t use your school’s SSD coordinator to submit a request, it is also possible to submit a paper request to College Board. This method takes longer, since you are mailing documents rather than sending them online, plus you will have to provide much more documentation. First of all, to get the form, you either need to pick it up from your school’s SSD Coordinator or request it from College Board’s SSD department, whose contact info is below. There is no way to download it online. Email info@ssd.collegeboard.org Phone 212-713-8333 Fax 886-360-0114 TTY 609-882-4118 Mail College Board SSD Program P.O. Box 8060 Mt. Vernon IL 62864-0060 Once you get the form, you will list your personal information, your high school’s College Board code, and the date of your desired SAT test. (Note that this form does not double as a test registration form, you will still have to sign up for the SAT after you get your accommodations.) Next, you will state which accommodations you are requesting. Make sure the accommodations are specifically linked to your disability, and do not repeat. (For example, do not request both a reader and a cassette player if you need the test read aloud.) Also make sure you provide information about those accommodations, including your history of using them at school, and your performance with and without accommodations. (For example, if you are requesting extended time, include a comparison of your work ability in timed and untimed conditions.) Finally, and most importantly, you will provide documentation about your disability. This includes information about your IEP or 504 Plan if you have one, most recent cognitive or ability testing, and most recent medical evaluation if you have a medical or psychiatric disability. Documentation required will vary by disability and the accommodation(s) you’re requesting. Your documentation must be very detailed – not just a medical note or your IEP. History of your symptoms, accommodations given in school, and the reason accommodations are necessary for the SAT are all necessary information. You can find more fine print on documentation here. Okay, so it might not take this much documentation to get SAT accommodations, but it might feel like it! You can find complete instructions and requirements for completing the paper form at College Board’s website. Once you send in the form, College Board will first verify that you have sent in all necessary documentation, and request more if needed. After that, they will either approve or deny your request. Approved? If your request for accommodations is approved, your accommodations will remain in place until one year after you graduate high school. So once you’re approved, you don’t have to worry about ever going through the process again! College Board will give you a seven-digit code to use whenever you sign up for a test online. You will be able to use your accommodations on all College Board tests, including the PSAT, SAT, SAT Subject Tests, and AP Exams. To use them on SAT and SAT Subject Tests, use your code when you sign up online. For the PSAT and AP Exams, inform your school you receive accommodations from College Board and they will make sure your accommodations are in place on test days. If you have to change your accommodations, either inform your school’s SSD Coordinator and have them submit the request through SSD Online, or submit your request independently. Again, the fastest way to change your accommodations will be by going through SSD Online, so use that if possible. More Hints and Tips If you need accommodations, get them as early as possible in your high school career. Since College Board’s accommodations will last until after you graduate, the earlier you get your accommodations the more you will be able to use them – especially on AP Exams and the PSAT, which you may begin taking as a sophomore or even a freshman. If you’re unsure if you need or want accommodations on the SAT, consider your situation. If you’re on an IEP or 504 Plan that grants you extra time, breaks, or tools on tests, it’s highly likely you will also benefit from those accommodations on the SAT. Remember, the SAT is a very challenging test that requires a ton of mental processing, math calculations, and writing in a short period of time. Plus, it will be easier to get accommodations on the SAT if they are similar to ones you have been using in school. If you are not on an IEP or 504 Plan at school, but have a condition that will make the SAT difficult, consult with your school’s SSD Coordinator about taking the SAT with or without accommodations. It will be harder – though not impossible – to get accommodations if you are not on a plan with your school, so determining if you need them will be an important first step. You could also try taking SAT Practice Tests with and without the accommodations you think you will need to get a sense of if you want to request them. For example, if you think you will need extra time, try taking one practice test using typical SAT timing, and one with extended time. If your condition or disability makes it markedly more difficult to complete the SAT in the allotted time, consider seeking out the accommodation. Don’t underestimate the SAT! Finally, whether you end up getting accommodations or not, make sure you take enough time to study and prepare for the SAT. It is a very difficult test, and will not be like tests you take for class or standardized state exams. Along with your necessary accommodations, smart studying is the best way to be ready for the SAT. What’s Next? Once you get your accommodations, what score should you aim for? Learn about the average SAT score, the average SAT score in your state, and how to develop your own personal target score. Curious about how the SAT is scored? Learn how your answers get turned into a composite score between 600 and 2400 and how to use that information to your advantage. Stressed about taking the SAT? Learn about the three most common sources of anxiety and how to cope with them. Want to improve your SAT score by 160 points?We've written a guide about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now:

Legal Positivs and the Rules of Law Essay Example | Topics and Well Written Essays - 1250 words

Legal Positivs and the Rules of Law - Essay Example This provides for the security of the people as manifested by the institution of a government willing to be able to enforce it for the benefit of the majority of the population at the very least. Law and morality are destined to be intertwined for they serve the same purpose and to establish a thought of segregation in a positivist perspective would essentially diverse any of its very nature. Any law, even if it does presuppose to be primarily lacking of moral substance finds the very same although in what may be a distorted moral view of the few to rendered it into being. The source of any law must come from a moral perspective and this is inculcated therein by spirit. The discussion on the Utilitarian proposition on the distinction of law and morals has long found its way to stimulate conversation and debate over the great legal minds and has spanned centuries in the process. Austin said in his book ‘The Province of Jurisprudence Determined’ that â€Å"A law, which ac tually exists, is a law, though we happen to dislike it, or though it varies from the text, by which we regulate our approbation or disapprobation† (p.184). This has then on been the subject of reference by discourse from other authors in the legal profession. This is perhaps another source of the thesis found Hart’s article of his distinction between what law is and what it ought to be. Thus from this discussion of Hart we were introduced to the exemplification of the German woman who has divulged to the military her husband’s resentment to Hitler which was a source of punishment for the latter by virtue of a statue. Later on the wife was found guilty by the appellate court under the German Criminal Code of 1871 for denouncing her husband to the German courts (Hart, p.2). This law clearly antedated the woman’s act and the decision can be perceived to be fuelled primarily by the moral institution of the law by the court. But what concerns Fuller on Hartâ⠂¬â„¢s argument although the same was not an absolute positivist in the same level as Austin, was Hart’s position on a mere intersection of law and morals instead of clear convergence of the two. He then answered in retort and quite aggressively that the content of Hart’s article is confusing in the same way that the writer may have been just as confused of his hypothesis himself (Fuller, p.630). But despite this criticism, Hart’s one rhetoric finds its way to be an effective question that permeates through. Consequently, he asked â€Å"Why should we dramatize the difference between them?† (Hart, p.3). Why indeed? Throughout the history of this debate it is fathomable that the minds behind the idealization of positivism such as Austin have parted their wisdom at a different day and age while the Utilitarian philosophical suggestion was a way of being. This enables for the advocacy toward strict adherence to the law devoid of moral rationalization. A law i s a law and as such must be followed to the letter. This renders the same to be an object of absolute prowess that could find its fault in the legislation process and the adverse outcome of which to be experienced during its actual enforcement with the weight of the law to be imposed by the courts of justice tasked to interpret and ultimately apply the law as worded by the legislative body. A law as a positive manifestation is a truth which may not be rendered otherwise. This

Compare and contrast the Right to Remain Silent in the US and the UK Essay

Compare and contrast the Right to Remain Silent in the US and the UK - Essay Example On March 13th 1963 Ernesto Miranda was arrested in Arizona and taken to the Phoenix Police Station where he was then identified by the complaint-filing witness. Without being notified of his rights, Miranda was led into the interrogation room and questioned by police officers. In two hour’s time the officers had succeeded in obtaining a written and signed confession from Miranda. The signed statement claimed he signed it â€Å"with full knowledge of my legal rights, understanding any statement I make may be used against me.† When the case went to trial the prosecution used Miranda’s statement of confession against him and despite objections from the defense, the judge allowed for the confession to be admitted as evidence. Miranda appealed and the Supreme Court of Arizona ruled his rights were not violated because Miranda never requested council to be present during questioning. Miranda’s case went before the Supreme Court who acknowledged Miranda was never informed of his right to council or the right he had not to â€Å"be compelled to incriminate himself.† The Supreme Court ruled since Miranda did not have full knowledge of his rights all statements made by Miranda were inadmissible in court since they were not legally received. Furthermore the Supreme Court justified that since interrogation is intimidating, a suspect must first be given their rights to lessen the intimidation they experience. The Miranda Rights must be read before a suspect is to be questioned or interrogated in any way. The Miranda rights are read as followed: â€Å"You have the right to remain silent and refuse to answer questions. Do you understand? Anything you do say can and will be used against you in a court of law. Do you understand? You have the right to consult an attorney before speaking to the police and to have an attorney present during questioning now or in the future. Do you understand? If you cannot afford an attorney, one will be appoint ed for you before any questioning if you wish. Do you understand? If you do decide to answer questions now without an attorney present you will still have the right to stop answering at any time until you talk to an attorney. Do you understand? Knowing and understanding your rights as I have explained them to you, are you willing to answer my questions without an attorney present?† (essortment.com) The 5th Amendment to the US Constitution’s Bill of Rights is â€Å"No person shall be compelled in any criminal case to be a witness against himself or be deprived of life, liberty or property without due process of law.† The 6th Amendment Right to Counsel Clause coincides with the 5th intricately and was instituted in 1964 from the case of Escobedo vs. Illinois by the Supreme Court’s insistence that police allow council to be present during questioning. â€Å"In all criminal proceedings, the accused shall enjoy the right to have the assistance of counsel for h is defense.† (flexyourrights.org). In historic times, such a notion as the right to silence did not exist. In the 18th century English Criminal procedure made it impossible for a suspect of a crime to protect themselves from self-incrimination. Common law refused a criminal the right to be defended by a lawyer therefore persons suspected of a crime had little choice but to speak for themselves because no one else was going to. Refusal to speak and answer questions was quite the same