Confidentiality: Childhood and Sensitive Information Essay

the principles and boundaries of confidentiality are to do with safeguarding children and young people. The principle – or main reason for having confidentiality in settings is to maintain positive, supportive, respectful relationships with children and young people that recognises each individual’s right to privacy, their right to protection and their right to free expression. This could be done by finding quiet less public areas for discussing information, ensuring information given within a setting isn’t repeated outside of the setting for less professional reasons, everyone connected with a setting understands how sharing information relating to safeguarding is valued and welcomed. A boundary of confidentiality is that it isn’t always appropriate/safe to keep information confidential where there may be a risk of harm to a child or young person. Confidentiality is essential in schools. The same rules of confidentiality apply whether you are employed by the school or you are working as a volunteer. You may have been told sensitive information about a child because it helps you to carry out your role, for example, about their health or particular needs. This is sensitive information and should never be a topic for discussion in the staff room or with other parents. As a teaching or learning support assistant, you may find that parents approach you to tell you personal or sensitive information. You must let them know that you would need to share it with your manager or supervisor. Information can be passed on without permission when a child is at risk of abuse or harm. However, the information should only be passed to specific people who ‘need to know’. They can then take action and provide support to protect the child. If you are in doubt, you should always ask for advice. Information sharing In some circumstances, when a child may be at risk of significant harm, information can be shared without consent with professionals who need to know. Failure to share information has been highlighted in a number of serious child abuse cases. Sharing information ensures that problems are identified early and action is taken when children are thought to be at risk of abuse. There will be systems within your school on ways that this is done. You should always ask for advice before sharing information. and from the Collins SCH 21 chapter – and title on amazon It is best to treat everything you learn about children and their families in your workplace as confidential information; it is advisable to check with your supervisor before you pass on confidential information. Similarly, it is always best to tell your supervisor if you receive any information that concerns you. If someone wants to tell you something ‘in confidence’, you should say that you may not be able to keep the information to yourself because part of your job involves safeguarding children’s welfare. It is then up to the person to decide whether to tell you or not.

Eva’s death Essay

Also at the beginning of the play, Mr and Mrs. Birling come across as a well-off couple who are very well educated and in the public eye a lot when Mr Birling says to Gerald, â€Å"I could be in line for a knighthood, providing nothing goes wrong.† This means that if a scandal is linked with his family, then the public will turn against him, and therefore he won’t be able to get a knighthood. Because of this, the audience wouldn’t expect them to behave in the way they did, and when we find out what they did, and the affect they had on Eva Smith/ Daisy Renton, it’s quite shocking to see that they were both somehow involved in her death. And when we find out the reasons behind what they did, it changes the impression we get of them, and you see that they are quite selfish and take advantage of the power they have and who they inflict it upon. They are both quite wrapped up in their own lives, and anything that would lose them money or cause them grief, they take no notice of and dismiss the idea. Sheila and Eric are Mr and Mrs. Birling’s children. At the beginning of the play Sheila comes across as a bit childish and immature and maybe still relies on her mum and dad a lot when she say, † yes, go on, mummy. You must drink our health.† We get an impression of Sheila as being naive and shallow, but her comment, â€Å"last summer, when you never came near me,† which refers to Gerald, may suggest to us that she isn’t as stupid as she may seem. Eric seems a bit more mischievous and much more naive than Sheila, in the way he talks and how he acts. He seems embarrassed and nervous, as soon as he is mentioned in the play, as it says, â€Å"Eric suddenly guffaws,† and then doesn’t tell the other characters why he came out with it, which suggests he is nervous about something, which we later find out that it is the money he recently stole from his father, Mr. Birling. hI think Mr and Mrs. Birling are more ashamed of Eric and careful that he doesn’t do anything stupid to embarrass the family, but the family seem to get on with each other quite well, although you get the impression that there is some tension between Eric and Mr. Birling, when Gerald, Mr. Birling and Eric are talking about women’s love of clothes before the Inspector arrives. Sheila also has a link with Eva, who was employed at ‘Milwards,’ because Sheila thought Eva, was laughing at her when she tried on a dress that didn’t suit her. Eva was prettier than Sheila and the dress suited her more, which made Sheila irritated and envious of Eva, so she was guilty of a deadly sin, which was envy. Eric’s link with Eva was that he met her in the palace bar one thing lead to another and he got her pregnant, which made him guilty of lust towards Eva. Although Eric doesn’t seem very responsible he shows some initiative, as he was concerned enough to give Eva some money, which shows his priority was Eva’s future and not necessarily the consequences of stealing from Mr. Birling’s office. I don’t think the audience are too shocked to find out what Eric and Sheila are capable of, because they are young and quite naive, and they don’t seem to have much empathy towards other people, maybe because they haven’t experienced the things Eva has before. Their actions can be linked to their parents as they have a lot of power, so this may be filtered down to them, which they might exploit and take advantage of. By the end of the play Eric and Sheila have changed more than the other characters. Sheila feels extremely guilty for what she has done to Eva and frequently cries and sobs when the Inspector mentions Eva in the infirmary. Eric also feels guilty for what he did to Eva, he says, â€Å"the girl’s dead and we all helped to kill her- and that’s what matters.† I think they have both changed because they are young and impressionable, whereas Mr and Mrs. Birling refuse to take responsibility for Eva’s death to save their reputation, and they have never been forced to examine their consciences before and they find that they can’t do it now, and are relieved when they find out the Inspector wasn’t real and want to forget about it and move on. At the start of the play we find out that Gerald is from a family who are socially better than the Birlings. We know this because after Mr.Birling tells Gerald he has the same port as his father gets, Gerald says, â€Å"The governor prides himself on being a good judge of port†. Gerald is also described as â€Å"an attractive chap about thirty, rather too manly to be a dandy but very much the easy well-bred man-about-town.† We also know that he is the son of Lord and Lady Croft, and we are given the impression that they are not to keen on the engagement of Gerald and Sheila as they didn’t accept the invitation to the dinner. This makes us wander why Gerald would want to marry a woman of a lower status than him. Gerald was involved with Eva when he met her at the palace bar and let her stay in his friend’s empty flat in Bromley, as she had nowhere to stay, and he felt sorry for her. Eva, or Daisy Renton as Gerald knew her as, was his mistress for a time until she had to move out because Gerald was away on business. His involvement with Eva was different to the rest of the characters, because he actually tried to help her and did something good. In a way his actions are the most shocking because he is better-off than even the Birling’s, so you wouldn’t expect him to help out someone like Eva who hangs around in places like the palace bar, and you would have thought he would look down on people like her, and have no sympathy for them. I don’t think his actions fit in with the Gerald at the beginning of the play because he tells Sheila the reason why he didn’t see her much last summer was because he was busy at work, when he was with Eva at the flat, so we find out he was lying to Sheila, which you wouldn’t have thought he’d do as he says he wants to be part of the family and they seem to have a lot of respect for each other. Although Gerald seems moved by the news of Eva’s death, he isn’t entirely willing to admit his involvement with her, and this could be because of the same reason as Mr. Birling, that he wants to protect his own interests. At the end of the play he tries to come up with as much evidence as possible to prove that the Inspector isn’t real, which could potentially get him off the hook, if he could convince the rest of the characters that they had been hoaxed.

The authors explore the question of bankruptcy in public companies

The authors explore the question of bankruptcy in public companies, trying to come up with ways of predicting the looming bankruptcy. Pointing to the growing scale of this harmful phenomenon with a greater number of larger companies going bankrupt, Chuvakhin & Gertmenian are trying to present businessmen with a framework for analysing the performance of business companies so as to receive indication of their problems before they are forced into bankruptcy.To arrive at this understanding, they utilise Z-score model constructed by Edward Altman in 1968.The attempts to arrive at a ratio that could serve as a bona fide predictor of the upcoming bankruptcies have been undertaken for years, including a study by William Beaver. The critical breakthrough came when Edward Altman â€Å"built a comprehensive, statistical model using a technique called multiple discriminant analysis (MDA)† (Chuvakhin & Gertmenian, n.d.). The model relies on the combination of five different ratios that ca n later be summarised into a so-called Z-score.Altman indicated that a company with a Z-score above 2.675 could be considered solvent, that with a score under 1.81 was liable to go bankrupt, and companies with Z-scores in the range of 1.81-2.675 fell into â€Å"gray area† or â€Å"ignorance zone†, which meant that they could escape bankruptcy, but with difficulty.The legal issue explored in the articles refers to companies that forge numbers in their books, deceiving investors, as in the case of Enron and WorldCom. The authors ask: Is it possible to predict bankruptcy if the company’s management is cooking the books?Their answer is yes since the Z-score model would avoid these accounting irregularities. For example, in the case of WorldCom that overstated both assets and earnings, the combination of ratios used by the model would overlook it, since a rise in earning would increase the first three ratios, but a rise in assets would decrease the last two, with the impact offsetting each other.The model outlined in the article is of great value to managers of different companies. From the managerial perspective, it is extremely important which of the firm’s customers are likely to go bankrupt. If the bankruptcy of a large client comes a like a bolt of lightning, totally sudden and unanticipated, the firm can end with a large amount of bad debt in its accounts receivable account.In 2001 alone, bankruptcy affected 257 public companies with combined assets of $256 billion (Chuvakhin & Gertmenian, n.d.). In the light of this fact, effective methods for bankruptcy prediction become a serious concern for managers.

Internal Auditing Case Study Example | Topics and Well Written Essays - 500 words

Internal Auditing - Case Study Example One of the internal control mechanisms that the organization failed to utilize optimally is preventive control. Preventing control in internal auditing is essential because it is the first barrier that protects the organization from risks that are detrimental to its performance, growth and financial stand. The principal risks are operating errors, technological malfunction, negative regulatory pronouncements such as unfair suspensions of employees, and fraud. In Krenik’s case, the risk that internal audit failed to stop was Fraud. Had there been a strong internal control, the organization would have developed a transparent payment system such as e payables systems that would have prevented fraud (Rezaee, 2002). Detective control plays a key role in spotting irregularities that have already happened within the organization. The aim of detective control is to develop necessary methodologies and tools that can easily spot errors and irregularity within the functional areas of the organization. In this internal auditing measure, internal auditors are useful when testing risky processes and procedures. In Krenik's case, the organization failed to detect fraud because it did not have an ardent detective control mechanism that would have detected financial malpractices and it took the intervention of the bank to detect the fraud. Failure to regularly reconcile financial documents between US Airforce and the supplier and inability to make appropriate and regular follow -up of payment procedures provided a loophole through which fraud occurred (Frigo, 2002). Corrective control in internal auditing assists in correcting irregularities and errors that have been spotted within the organization’s financial data and operations. In Krenik’s case, the corrective measures to prevent future frauds are developing strong preventive control measures such as prompt and through reconciliation of transactions with the suppliers, developing an electronic payment system that is efficient and fast, and conducting regular checks on financial statements’ information.

Money Crisis Essay Example | Topics and Well Written Essays - 2000 words

Money Crisis - Essay Example To sell more profitable subprime mortgages, mortgage companies bundled the debt into consolidation packages and sold the debt on to other finance companies. In other words, mortgage companies borrowed to be able to lend mortgages. For example, the lending was not financed out of saving accounts (Mortgage Guide). These mortgage debts were bought by financial intermediaries. The idea was to spread the risk, but, actually it just spread the problem. Usually subprime mortgages would have a high risk assessment rating. But, when the mortgage bundles got passed onto other lenders, rating agencies gave these risky subprime mortgages a low risk rating. Therefore, the financial system denied the extent of risk in their balance sheets (Mortgage Guide). Many of these mortgages charged a balloon interest rate in which, they charge low interest rates in the initial period, but at the end of the introductory period interest rates rise rapidly (Mortgage Guide). In 2007, the US had to increase interest rates because of inflation (BBC). This made mortgage payments more expensive. Furthermore, many homeowners who had taken out mortgages two years earlier now faced ballooning mortgage payments as their introductory period ended. Homeowners also faced lower disposable income because of rising health care costs, rising petrol prices and rising food prices. This caused This caused a rise in mortgage defaults, as many new homeowners could not afford mortgage payments. These defaults also signaled the end of the US housing boom. US house prices started to fall and this caused more mortgage problems. For example, people with 100% mortgages now faced negative equity (Mortgage Guide). It also meant that the loans were no longer secured. If people did default, the bank couldn't guarantee to recoup the initial loan. The number of defaults caused many medium sized US mortgage companies to go bankrupt. However, the losses weren't confined to mortgage lenders, many banks also lost billions of pounds in the bad mortgage debt they had bought off US mortgage companies. Banks had to write off large losses and this made them reluctant to make any further lending, especially in the now dangerous subprime sector (Shah). The result was that all around the world, it became very difficult to raise funds and borrow money. The cost of interbank lending had increased significantly. Often it was very difficult to borrow any money at all. This affected many firms who had been exposed to the subprime lending. It also affected a wide variety of firms who now have difficulty borrowing money (Shah). The slowdown in borrowing has contributed to a slowing economy with the possibility of recession in the US and all around the world. Credit Crunch in the UK UK mortgage lenders did not lend so many bad mortgages. Although mortgage lending became more relaxed in the past few years, it still had more controls in place than the US. However, it caused very

Hange of effects of warfare on combatants due to new technological Essay

Hange of effects of warfare on combatants due to new technological advancements since Second Industrial revolution - Essay Example These changes are multidimensional and complicated. Most of the ideas and opinions have been propounded by the means of an example-based approach. Dependable sources for reference purpose have bee carefully selected and utilized. Research Question How have the effects of warfare on combatants changed as a result of new technologies of warfare since the Second Industrial Revolution (c. 1850)? Thesis Statement The changes in the effects of warfare on the combatants due to the utilization of post Second Industrial Revolution weapons technology have made them more impersonal, lethal, cruel, and confident. Armed Conflict Becomes More Impersonal and Lethal The effect: Since the Second Industrial Revolution warfare has become increasingly dependent on technology. This dependence has caused armed conflict to become progressively more impersonal and lethal. Discussion: The modification in the nature of armed conflicts is due to the fact that the combatants are becoming more impervious and als o they are lethally very much enabled. In the ancient and medieval ages, combatants used to fight each other in battlefields that generally did not cover the civilian areas. One-to-one battles were not unknown between the warriors and that used to be a matter of glory. Weapons like swords and spears could kill only one combatant at a time. But mass killing by using incendiary bombing, as had been seen in Germany and Japan, testify the fact that the new technologies have made the combatants extremely lethal (Grossman, 1995). Before the Second Industrial Revolution, a warrior has a glorious appeal. He/ she could be a crusader, a protector, or a savior. This appealing warlike personality cult motivated the youth during the post Second Industrial Revolution wars as well. The World War I is a good example of this. But with the advent of new technologies, the appeal of valor culminated at dangerous impersonal missions (Dennis, 2001). According to Smith (1983), â€Å"The introduction of t he gun will serve in the future to make war more rational and less the product of purely personal enmity.† In ancient warfare, we find personalities like Hector and Achilles who fought for personal glory. However, generals like Trotsky led the masses for almost completely impersonal movements. Rapid fire and faster and widespread communication actually impersonalized warfare (American Political Science Association, 1983). As for lethality once again, World War I provides a good example. Infamous chemical warfare during this period had made the ground reality similar to â€Å"Dying like so many rats in a trap† (Cook, 2002: 47). Such situation never came up in the wars of the ancient civilizations. Increased Cruelty The Effect: Second Industrial Revolution has begot such war techniques that cannot be limited among the combatants only. In modern warfare, the degree of civilian casualty is very high and this fact testifies for the increased cruelty of the combatants. Discus sion: Atrocities committed by the ancient and medieval combatants were less terrific and had lower psychological effect. In technology-based modern warfare, things are different; especially, psychological effects are too profound. Siege warfare is an important sub-discipline in this regard. During the siege of the cities in the pre 1850 environment, less prominent terror techniques were generally used. Examples of medieval siege warfare like the Siege of Calais (France) by British forces show that human values prevailed to at least some extent in the war. Although siege of Peking by the

History of Photography. Lewis Hine, Steelworkers, Empire State Essay

History of Photography. Lewis Hine, Steelworkers, Empire State Building, New York, 1931 - Essay Example In this essay I will focus on Lewis Hines photographs of men working on top of the Empire State Building skyscraper, which were taken in different years of its construction. I will try to compare the well-known Hines photograph titled as Steelworkers, which he took in 1931, with a number of other similar photographs taken by Lewis Hines atop of the Empire State Building in 1930s. Lewis Hines breathtaking photograph titled as Steelworkers,1 which he took on top of the Empire State Building in 1931, became a hymn to work and splendor of a great deed that a man could do to achieve the goal, no matter how incredible it might seem from the beginning. This amazing image shows two steelworkers on top of the skyscraper and makes one wonder how it is possible at all to work at such height without suffering vertigo. One can see a part of Manhattan on the background; the rest of the buildings down below seem so small comparing to the work place of these two brave men on top of the skyscraper that the image of them doing their ordinary work inspires admiration with courage and self mastery of these steelworkers sitting atop of one of the highest buildings in New York City. This photograph is a manifest of the fortitude of a man and incredible ability to overcome difficulties and dangers, although the scene of men at such height risking their lives to get the work done i nspires with awe. While one of the steelworkers is sitting on the beam holding the screw-bolt, another worker is using the electrical screw-driving machine to screw the bolt into the beam until tight. It is amazing how these men sacrifice their safety and risk their lives to erect the construction, where people would feel themselves perfectly safe one day. The calmness of these two men is an art itself. Both of them smile knowing that Hines is taking a photo of their work, but dont look at the camera as they are

Corporate Social Responsibility in Mitsubishi Essay

Corporate Social Responsibility in Mitsubishi - Essay Example However, Kotler and Lee (2004) defined CSR as the â€Å"commitment to improve community well-being through discretionary business practices and contributions of the corporate resources† (Kotler &Lee, 2004, p.3). In any case, the importance of CSR was established in the corporate world only at the beginning of the twenty first century. Big companies realized that profit making is no more an easy task, if they fail to contribute something to the community in which it operates. Some companies have good track record of exhibiting their social responsibility whereas some other companies are still neglect the needs of the community in which they operate. Mitsubishi Company is a reputed Japanese company as far as corporate social responsibility is concerned. â€Å"The origin of Mitsubishi goes back to 1870, when the founder, Yataro Iwasaki, started a shipping firm with three aging steamships† (Mitsubishi: Origin, 2010). After Second World War, the original Mitsubishi Company d isbanded to become separate independent companies as we witness today. The growth of Mitsubishi Company was along the growth of Japan. Whenever, Japanese economy faced troubles, Mitsubishi Organization also faced problems and vice versa. Mitsubishi selected London for opening its first international office in 1915 because of Japan’s better relationships with Britain at that time (Rudlin, 2000, p.8). Since then Mitsubishi opened many international offices at different parts of the world. â€Å"Mitsubishi International Corporation (MIC) conducts business in accordance with the three Corporate Principles established by its parent, Mitsubishi Corporation: corporate responsibility to society, integrity and fairness, and international understanding through trade†(Mitsubishi international corporation: Corporate Social responsibility, n. d). Even though, Mitsubishi is contributing heavily to the communities in which it operates, there are certain allegations also against them. This paper briefly analyses the case in favor and against Mitsubishi Company as far as corporate social responsibility is concerned. The case against Mitsubishi Robert Guest, British free-lance writer based in Hiroshima who contributes business and other articles to The Far Eastern Economic Review and The Independent, has mentioned that an Indian Worker Sue against Mitsubishi citing racial discriminations. The plaintiff alleged that â€Å"whereas Japanese employees at Mitsubishi are given English-language lessons at company expense, and Caucasian staff are provided with the best Japanese-language teaching available, he has been given no assistance whatsoever in his efforts to learn the Japanese language†(Guest, n. d). Racial discrimination is one of the major problems existing in the premises of most of the international companies. Globalization has brought many opportunities to the corporate companies to for international businesses; however, most of the companies like Mits ubishi, try to give more preferences to their local workers even while operating in overseas countries. Such business practices will always cause severe problems to a company if it decides to operate internationally. On 9 April 1996, the US Equal Employment Opportunities Commission (EEOC) filed a class action lawsuit in federal court in Illinois against Mitsubishi Motor Manufacturing of America Inc which claimed that over 300

Reaction Time & Hemispheric Asymmetry Dissertation

Reaction Time & Hemispheric Asymmetry - Dissertation Example The tests failed to demonstrate a clear association with hemispheric aptitude in terms of reaction speed based on results of previous investigations in the literature. Introduction The two halves of the human brain are responsible for different perceptions and styles of information processing. Handedness as a functional preference begins with an entire half of the brain, one of which is personally dominant, and it is that dominant half that is used to process much information. Nonetheless, cognitive functions are enhanced when both sides of the brain learn to get along cooperatively, sharing capabilities in a balanced fashion. To optimize this sharing for the benefit of performance, there should always be room for strengthening whichever a person's weaker hemisphere happens to be. The left brain functions in a sequential, linear manner. It is an organizing, rank-making, list-maker. Left-brained individuals enjoy orderly planning, schedule-creation, and structured organization. Left-b rains finish tasks in sequence and enjoy the regularity that this regimented approach allows. And thus, learning in sequence can be easier for these individuals. Functions such as spelling are probably easier for left-brains. A sequential approach to mathematical calculations and stepwise directions are ideal conditions for this learner. This left hemisphere is also vital for many forms of communication. Aphasia can result from trauma, tumors or stroke-damage to the left hemisphere. Certain complex mouth-movements may be affected also. It is clear that language processing as well as spatial intelligence, and subtle movements involving hand-gestures are dependent on the left hemisphere. (Toga et al. 2003) In seeming opposition is the approach of the right-brained thinker. More haphazard and spontaneous. The right-brained thinker may drift through different modes and styles of thought. They may lack the regimented prioritization of the left-brained operator when they do complete the w ork they have set themselves towards. They may not accomplish less, but in a less direct fashion. A task may be delayed not because the right-brained wasn't applying themselves, but that they were applying themselves to many different priorities. Excessive regimentation provokes feelings of restlessness or rebellion. But schedules and order are still useful, and are perhaps more essential for this thinker. Editing, error-correction and spell-checking will be more important for this learner. Colors and images may be useful to this thinker as an organizational tool, as vivid depictions will be impactful for a right-dominant mind. Mnemonic devices should be the most beneficial for this thinker. In addition, the right cerebral hemisphere specializes in spatial perception and topographical comprehension, and men score higher than women when the input is restricted to the right hemisphere, or conversely, obtain significantly lower scores than women on such tasks after damage to this hemis phere. The left hemisphere specializes in language, and trauma here leads to aphasia, linguistic impairment in speaking, comprehending, or both. The fact that women score lower than men in right hemi-sphere tasks was for years explained in terms of the crowding out effect, a concept referring to the left hemis

The Pythagorean Theorem Essay Example for Free

The Pythagorean Theorem Essay The Pythagorean Theorem (Proof): James Garfield (1876), later president of the United States, while serving in the House of Representatives, discovered the proof of the Pythagorean Theorem, using trapezoid. Suppose, trapezoid bases are ‘a’ and ‘b’ and height (altitude) is equal to ‘(a+b)’. Therefore, Area of the trapezoid = In addition, as shown in figure, trapezoid consists of three triangles 1, 2, and 3. Combined Area of Triangles 1, 2, and 3 = Since, combined area of triangles is equal to trapezoid area, therefore, A real-world application problem: A real world application example of the Pythagorean Theorem is designing of a ramp for disable persons. Question: Assume that ramp height is 15 feet and suggested ratio (i.e. slope) for designing of ramp for disable person is approximately 1/12 (given). Calculate ramp length. The ramp length can be calculated as follows: Length of base of ramp = 15*12 = 180 feet. Using Pythagorean Theorem, Length of ramp = = =≈ 180.624 feet    Reference: Weisstein, Eric W. Pythagorean Theorem. From MathWorldA Wolfram Web Resource. http://mathworld.wolfram.com/PythagoreanTheorem.html

Nursing Care Plan for Post Operative Knee Pain

Nursing Care Plan for Post Operative Knee Pain EMORY UNIVERSITY NELL HODGSON WOODRUFF SCHOOL OF NURSING NRSG 360 Clinical Nursing I Clinical Work Sheet for Weekly Clinicals OVERVIEW: (Preparation for clinical week 2) Client’s Initials__L.W________ Age 74YRS___Admit Date_11/17/2014____ and/or Procedure Date _11/17/2014________ Today’s Date_11/20/2014________ Medical Diagnosis/Reason for Admission __Post-operative _pain____ Admitting Diagnosis: RIGHT KNEE REVISION Describe (Brief Pathophysiology in your own words, including HPI)__Patient is a 74 years female with right knee revision due to acute post-operative pain came in for surgical consultation due to continued pain and a valgus deformity after having cast removed. She is on hinged knee brace for stability. Allergies: Ancef, Tolectin 600, Cephalosporins Social Hx Patient is a retired pharmacist, married with children. She is alert and oriented x4; uses tobacco before but quitted 20years ago.__________________________________________________________ HOW ARE THE ABOVE ITEMS RELATED? (Preparation Add on by Clinical week 3) Treatments (Accuchecks, dressing changes, PT, OT, RT, activity order, diet, Isolation, I/O) Medications (See Medication Summary) Systematic Concise Summary of Physical Assessment findings (See Checklist for Routine Bedside Assessment) General: (includes vital signs) BP: 119/69, P: 93, T: 73.3, R: 18, SaO2: 95, Pain: 8/10 Neuro: Alert and oriented x4, Pupils dilated and face expression is symmetry. Cardiac: Clear on S1 and S2. No extra heart sounds, murmurs, or ribs. Respiratory: Breathing is unlabored, chest movement is symmetric. Integumentary: (include wounds) Skin is normal, warm and moist, no skin discoloration. Wound dressing on the right knee and right femur edema. GI: Normal bowel sounds hyperactive in all quadrants. GU: Clear yellow urine Musculoskeletal: Active range of motion on upper extremities, impaired range of motion on lower extremities with brace on right leg. Right foot is dissented. Safety Concerns Fall risk, Pressure sore risk. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DIAGNOSIS: *Radiology results; lab; micro; orders Pertinent Diagnostic Tests This includes abnormal and significant normal. Test Date Findings/Results Implications/Nursing care X-RAY knee 1or 2 view right 11/17/2014 Degeneration joint disease Revision of the tibia and femoral X-ray chest 1or 2 view 11/12/2014 Cardiomegaly, Tortuous descending aorta, left basilar atelectasis. Surgery Lab Tests with Rationale for Abnormals and Implication of Findings: Name of lab Reference Range Level at Admit Level on Last Lab Nursing Implications Reason for level SS Date Level Date Level Red blood cell count 3.93- 5.22mmol/L 11/17/2014 2.8210E6/mcl 11/20/2014 2.6410E6/mcl Due to Surgery Hemoglobin 11.4-14.4 mmol/L 11/17/2014 7.9gm/dl 11/20/2014 7.4gm/dl Due to Surgery Hematocrit 33.3-41.4 mEq/L 11/17/2014 25.0% 11/20/2014 24.4% Due to Surgery mEq/L mg/dL Nursing Plan of Care Nursing Plan of Care NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) * Remember â€Å"Risk For† Diagnoses do not yet have defining characteristics! Acute pain Related to knee replacement surgery Subjective: As evidence by pain rate of 10/10 Objective: Lower extremity weakness. Nursing Diagnosis Statement: Acute Pain______________________________________________ PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) Patient Goal Patient will indicate pain level decrease to less than 5/10 Your Intervention: Administer pain medication Evaluation of Goal Goal partially met, Patient pain level was managed to a level of 6/10. Your Intervention: Facilitate Rest Your Intervention: Provide relaxation and guided imagery. Nursing Plan of Care Nursing Diagnosis Statement_____Ineffective coping ______________________________________________ NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) Ineffective coping Related to pain due to ineffective function Subjective: patient report of anxiety Objective: patient appears withdrawn PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) In patient terms only, summarize response to intervention Patient Goal (may have several) Patient will learn two coping skills Your Intervention: Encourage family support Evaluation of Goal Goal met, patient was able to relax by listening to , and daughter was there to give a moral support Your Intervention: Administer antidepressant /antianxiety medication Your Intervention: Involve relaxation therapy Nursing Plan of Care Nursing Diagnosis Statement: Risk for ineffective peripheral tissue perfusion. NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) Risk for ineffective peripheral tissue perfusion. Related to coagulating factors released by bone during surgery. Subjective: Objective: PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) In patient terms only, summarize response to intervention Patient Goal (may have several) Prevent clotting Your Intervention: Give anticoagulant medication Evaluation of Goal Goal met, Your Intervention: Encourage ambulation Your Intervention: Give compression stockings Nursing Plan of Care Nursing Diagnosis Statement: Risk for fall _________________________________________________ NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) Risk for fall Related to lower extremity weakness Subjective: Objective: PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) In patient terms only, summarize response to intervention Patient Goal (may have several) Prevent patient from falling Your Intervention: Assist with ambulation Evaluation of Goal Met, patient was able to ambulate to bedside Commode. Your Intervention: Make sure bed is in low position with the rails at the top of the bed up Your Intervention: Involve physical therapy References for your entire clinical worksheet: Ruth F. Craven, Constance J. Hirnle, Sharon Jensen, (2013) Fundamental of nursing: human health and function, (7th Ed). Philadelphia, PA: Lippincott Williams Wilkins Inc. Gulianick, M. and Myers, J. (2003). Nursing Care Plans: Nursing Diagnosis and Interventions. Mosby: St Louis Pearson Education http://wps.prenhall.com/ Nursing Central (200-2014) Using web sources in writing, Retrieved from http://www.unboundmedicine.com/ Schedule: *Pt Care Summary; Med list; Pt schedule; task list 7am Visit with patient and getting report from night shift staff. 8am Perform vital signs 9am Giving medication 10am Assist with morning care, mouth care, assist with bath. 11am Head to toe Assessment 12pm Assist to bathroom, Accu-check. State1 personal learning goal for this clinical day: ________Be able to give IV push and make my patient more comfortable. _________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Did you meet your personal goal for the day? _____________________________________________Goal Met, I was able to give IV push of 5% dextrose to my patient after noticing low level of glucose. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Checklist for Routine Bedside Nursing Assessment Mental/Neuro Status LOC Alertness/Orientation PERRLA Mood Behavior Check Patient ID Band Cardiopulmonary Heart Sounds Apical Rate/rhythm Lung sounds Breathing pattern Peripheral pulses Edema Capillary refill Hemodialysis Access – Graft/Fistula – bruit/thrill Oxygen Equipment Vital Signs BP P R Temp Pain SaO2 Gastrointestinal Bowel sounds Abdominal palpation Degree of ABD distension Bowel elimination problems (diarrhea/constipation/flatulence) Nausea/vomiting Genitourinary I O (quantity) Quality (color, clarity, burning) Continence/incontinence (Assistive devices) Reproductive problems/sexual concerns Motor Sensory Function ROM Paralysis Weakness_______________________________________________________________________________________________________________________________/Numbness/Tingling Assistive Devices Ambulation Wound Cleanliness Swelling/redness.infection Drainage Bandage dressing Integumentary Color Temp Turgor Moisture Integrity Braden Scale Score (Mon, Thurs: rescore at EUH) Invasive Tubes (IV’s, NGT, Wound drains, Catheters, etc..) Device and location IV Line(s): Fluids, Meds, Date of insertion/dressing/tubing Patency and position Redness, swelling, tenderness at site Drainage/Infusion rate Modified by Erin Poe Ferranti, 2005, 2007; Corrine Abraham, 2007 Adapted From: Elkin, Potter Perry (2004) Nursing Interventions Clinical Skills (3rd ed.) Mosby: St. Louis Medications MAR; MAR Summary: Medication Profile* Medication: Name/Dose/Route Time Classification Purpose Side Effects/Nursing Considerations OxyCODONE(10mg=1tab) 1 tablet PO 9:00 am Opioid analgesics Reduce pain Respiratory Depression May cause drowsiness Exenatide (10mcg injection) 1 each BID PRN Antidiabetics Lower blood sugar Pancreatitis, weakness Insulin aspart (BG > 150) (BG -100) /40= unit Antidiabetics Lower blood sugar Anaphylaxis, hypoglycemia Atorvastin (liptor) 20mg=1 tab, 1 tablet PO 9:00 am Antilipidemia Reduce Cholesterol level Chest pain, Rhabdomyolysis BuPRion 300mg=1tab 1tablet PO 9:00 am Antidepressant Treatment for depression Seizure, anxiety, dry mouth, depression ClonazePAM (0.5mg=1tab) 1mg=2tablets PO 9:00 am Anticonvulsant Prevention of seizure Fatigue, constipation, suicidal thought Docusate sodium (100mg=1cap) 1capsule PO 9:00 am laxative Prevent constipation Mild cramps, diarrhea, rashes Enoxaparin 30mg =0.3ml subq 9:00 am anticoagulant Blood thinner Constipation, urinary retention Levothyroxine (25mcg=1tab) 1tablet PO 7:00 am hormonal Treatment for hypothyroidism Tachycardia. Abdominal cramps Alprazolam (0.25mg=1tab) 9:00 am antianxiety Relief of anxiety Constipation, blurred vision Venlafaxine (75mg=1cap )150mg= 2capsule PRN Antidepressant antianxiety Decrease depression, anxiety and panic attack Chest pain, anorexia, itching, epistaxis Hydrocodone (10mg-1tab) 1tablet PO 9:00 am opioid Decrease pain Respiratory depression, apnea, anaphylaxis