Florence kelleys speech on child labor Essay Example for Free

Florence kelleys speech on child labor Essay In Florence Kelley’s speech to the National American Woman Suffrage Association, she connects with her audience and encourages them to fight for the end of child labor by showing how horrifying it truly it is. Through bringing up the horrors of child labor, she implies that women need the right to vote, as they would abolish child labor. By appealing to pathos, using imagery, and applying repetition, Kelley successfully convinces the audience to agree that child labor is wrong. Through appealing to pathos, Kelley connects with the audience’s conscience by showing how barbaric child labor and pushes her audience to desire the end of child labor. By stating that children â€Å"in age from six and seven years and eight, nine, and ten years†, work to provide for their families and themselves, Kelley strikes a chord in the listeners’ hearts and shows how this system takes advantage of young kids. This shows the monstrosity that is child labor as they are so young. As she writes that â€Å"boys and girls, after their 14th birthday, enjoy the pitiful privilege of working all night long†, Kelley shows that working all night is like forcing children into slavery. With the oxymoron â€Å"pitiful privilege†, she shows ironic it is that when a child has an important birthday, they are jokingly rewarded with longer work hours. Kelley connects with the audiences’ emotions as she shows how unjust it is to make children work as hard and as long as adults do. By describing the children as â€Å"little beasts of burden, robbed of school life that they may work for us†, Kelley makes the audience feel guilty for allowing child labor to be a common occurrence within America. By utilizing pathos, Kelley connects with her audience through proving how horrendous child labor is and calls them to action to rid America of it. Kelley also uses imagery to convince the audience that child labor is horrendous and should come to an end by vividly describing the working conditions that the child laborers go through and how young these workers truly are. She describes the children as, â€Å"just tall enough to reach the bobbins†, which brings to the audience’s mind an image of an innocent girl forced into working at such a young age. As she describes the harsh factory working conditions the children face, she points out, â€Å"the deafening noise of spindles and the looms spinning†. By using such descriptive imagery, Kelley transports the audience to the rooms where little children are suffering and working. Through placing these unforgettable images in her audience’s mind, she causes them to realize the unfairness and horror of child labor which they will never be able to forget. Another rhetorical device Kelley uses to convince her audience that child labor is a monstrosity is a repetition of certain phrases. Through repetition, Kelley pushes her words and facts into her audience’s head leaving them no room to deny the unfairness of child labor. Throughout her speech, Kelley repeatedly starts paragraphs with, â€Å"in (certain state)†. By doing this, she is able to state facts on child labor laws in certain states; showing that though there are laws on child labor, they are still extremely unreasonable and unfair. This shows the audience that child labor is very real and though they do not witness it, these kids make their items of comfort. She also repeats the phrase â€Å"while we sleep†. This repetition highlights that children work through the night, but more importantly, it implies that this occurs while everyone else is relaxing and sleeping soundly in their beds. By showing that children are forced to work extremely hard, the audience is left horrified. By utilizing repetition, Kelley successfully imprints the facts of child labor and its’ unfairness in the listener’s mind. In Kelley’s speech, she appeals to the audience’s conscience and emotions, paints vivid imagery, and uses repetition to call others to fight to end child labor as it is a horrendous occurrence.

An Honest Farmer Essay Example for Free

An Honest Farmer Essay The dictionary defines integrity as â€Å"an uncompromising adherence to a moral code† and ssys the word traces its origins to a Latin term meaning â€Å"untouched. † Here is integrity, untouched and unshaken by altered circumstances. There was a war in Germany long ago, and thousands of soldiers were scattered over the country. A captain of the cavalry, who had a great many men and horses to feed, was told by his colonel that he must get food from the farms nearby. The captain walked for some time through the lonely valley, and at last knocked at the door of a small cottage. The man who opened it looked old and lame. He leaned on a stick. â€Å"Good day, sir,† said the captain. â€Å"Will you kindly show me a field where my soldiers can cut the grain and carry it off for our army? † the old man led the soldiers through the valley for about a mile, and in the distance they saw a field of barley waving in the breeze. â€Å"This is just what we want. We’ll stop here,† exclaimed the captain. â€Å"No, not yet,† said the old man. â€Å"You must follow me a little farther. † After another mile or two, they came to a second field of barley. The soldiers dismounted, cut down the grain, tied it in sheaves, and rode away with it. Then the captain said to the old farmer: â€Å"Why did you make us walk so far? The first field of barley was better than this one. † â€Å"That is true, sir,† answered the honest old man, â€Å"but it was not mine. † farmer

Role Of Technology In The Operations Of Argos Marketing Essay

Role Of Technology In The Operations Of Argos Marketing Essay The organisation, Argos was founded in 1973 and is part of Home Retail Group (Parent Company). It is a generalized store, which sells a vast number of household products such as: household appliances, toys and games, DIY, sports and leisure, etc. According to the Times: Argos has a formidable grasp in most of the aforementioned markets. This establishments business model is based on a simple initiative: combine the comfort and the convenience of home selection (catalogues, internet, and phone) with the nearness of its high street stores. Since it first started out, Argos has always been noticed for its innovative use of technology similar to the way other organisations like Walmart, Amazon or Tesco utilize this type of technology. Computer systems have always had a huge impact on the way Argos functions as a retailer. Argos uses ICT to monitor stock levels, to recognise market developments earlier, to avoid stock shortage situations and to eliminate product theft. Tesco has a very similar business structure/model. Argos is convenient because of its integration with its virtual online business and its retail stores, just like the way Tesco operates; using its stores as its main core of operations. Argos also publishes two catalogues a year, the spring/summer edition at the start of January and the autumn/winter catalogue around mid-July. Finance and Accounting Argos is one of the UKs major non-fare retail groups. In 1998, after poor financial results, it was taken over by GUS (Great Universal Stores) plc. The then new appointed managing director Terry Duddy then set out to improve its performance. Part of Terrys job was to change the values and beliefs (the culture) shared at Argos. As stated in the Times 100 case study: The culture he (Terry) developed is one that values: customer service, teamwork, encouraging managers to take their own decisions, respect for each other and wanting to be competitive and improve. The Times then goes on to say that these values were clearly communicated to the employees; so that they felt more a part of the business. This clearly shows how Argos consulted with its staff to build a sound team, with team values such as: Welcoming change Being impatient to win Having lots of opportunities Working in teams Argos has built these values into its culture. To support this change, they also provided good introductory training, promotional opportunities and performance goals. As well as changing the culture at Argos, managers changed the marketing fusion. This consisted of the traditional Four Ps along with other issues which Argos thought important. Product. Market studies showed that the Argos brand was seen as dull and old-fashioned. Argos then modernised the brand with a new logo and new slogan: Brighter Shopping. It also extended its product range. Promotion. Argos advertises to separate market sectors. It divides its market by traditional ways but also uses brand awareness. As quoted from the Times: The get it group who know and understand the brand are used to help bring on board the dont get it group. Price. Argos continually keeps its prices as low as possible. Place (distribution). Argos continues to expand its retail market by opening new shops. Its catalogue is a key part of its distribution system and is found in 70% of British homes.  [2]   People Argos provides good training for its staff as part of its culture change. Process Alongside traditional shopping methods, Argos introduced Quick Pay and Text and Take Home. (Customers text to see if an item is in stock, and then reserve it to collect later) Quick Pay cuts down on queues by allowing customers to check availability, order and pay using credit or debit cards. Physical environment. Argos invested in improvements to make shops more appealing to consumers. As a result of these implemented changes to Argoss culture and the employment of technology. Argos now out-performs the market as a whole: Between the periods (2002-2003) sales grew by 13% and profits by 17%.  [3]   Sales Marketing For advertising, it (Argos) uses a variety of different media to promote its retail market, such as: television, radio, newspapers, catalogues, magazines, posters and the internet. Depending on which is the most beneficial and efficient at the time. This method of utilizing technology is very effective relating to attracting new and old customers namely by proposing: Value for money Convenience. Marketing managers at Argos are continually concerned with addressing questions such as: Who are our consumers? (Argos wants to discover as much information as possible on its customers in order to meet their requirements.) Are we proposing enough variety of products, appeal and convenience? How can we gain advantages over competition? (How is Argos different from the opposition?) How can we defend what trade we already have and how can we expand? How do we successfully interact with our customers? According to the website, computerworlduk, this year Argoss internet website accounted for 32% of the organisations total sales, 22% of which used the online click and reserve service. This shows how much of a positive impact the technology of the internet has had on this retail giant. However, compared to last years same interim sales review this year was 11% down, but despite the 11% fall in profits, online sales had significant growth. Argos sales ( £M): 2006 = 3,859, 2007 = 4,164, 2008 = 4,321, 2009 = 4,282, 2010 = 4,347Description: % Sales across more than one channel: Totals: 2006: 32 2007: 35 2008: 37 2009: 40 2010: 43 2010: Home delivery Store 7.7 Phone 1.6 Internet 9.5 Check Reserve Phone 9.5 Internet 22.5 Sales ( £M) (Picture on left) Definition: Sales in the 52 weeks to 27 February 2010 increased by 1.5% in total. There was further strong growth in televisions and personal computers, offsetting weakness in the video gaming market. Toy sales grew strongly. Challenging market conditions continued in home-related areas such as furniture, but the rate of decline moderated over the year. Source: audited financial statements. Sales across more than one channel (%) (Picture on right) Multi-channel sales grew to  £1.9bn or 43% of Argos sales. The internet represented 32% of Argoss sales; over two-thirds of this or 22% of Argos total sales were customers using online Check Reserve for store collection, with this channel growing by 36% for a second year in a row. Definition: Percentage of sales across more than one channel. There are three ordering channels: the internet, phone or store and two fulfillment channels, store or home delivery. Source: Measured internally. Argos has a multitude of unique marketing and sales strategies in retail. Argoss stated mission statement is: We provide our customers with the best value for money through the most convenient shopping experience. This statement clearly sets out the main areas which differentiate Argos from its rivals, namely by offering its customers. As stated in 2002 by managing director of Argos, Kate Swann. Customers can: Pick up a catalogue Choose at home (internet) Use a store to collect or order Use a store for collection point Order at home (telephone) Use home delivery She also specified that Argoss drivers for growth were: Small kitchen appliances (which it was in top position in 2001 for both value and volume) Beds and mattresses Watches Jewellery Portable audio Toys Retail Structure Tesco was the first to use such a structure; by combining its online website(s) with its supermarkets. Argos most likely adopted this similar strategy based on Tescos overwhelming success. However, Argos retail stores have minimal staff (unlike Tesco), and exploit technology to its full potential (like Tesco and Amazon). On an independent case study by Databank Consulting, they stated that: Argoss business model is a multi-channel approach: customers are offered different types of outlets for shopping. Prior to the introduction of the new e-channels, the customers could only browse the offer in the catalogue or directly at the store  [4]   They also suggested that Argoss success as a retailer has been based on its influential decision to adopt a technological based approach, by stating: The Argos website was launched in 1995à ¢Ã¢â€š ¬Ã‚ ¦Nearly 10 years later, Argos can be called a pioneer and leader in e-commerce. With www.Argos.co.uk, the company became UKs number two Clicks and Bricks retailer, combining both store based and online sales.  [5]   Before its decision to introduce a system called Nominated Carrier Scheme, the problem of receiving and delivering products was problematic and complicated, because every supplier has its own form of transportation, its specific method of documenting and specific time schedules. The decision was therefore to adopt a single system to bring together all the produce from suppliers and have them offered as only one delivery. This stock chain solution by UPS receives, validates and handles shipments from several hundred Argos suppliers. UPS then checks that the order is accurate, merges it with other orders and then sends it to Argoss own warehouses for the final delivery. Possible Improvements Argos could implement an improved stock ordering and restocking system. Argos stated that it would continue to roll out a voice put away process across all stores over the next two years. They then went on to say: This technology (voice put away) helps to automatically guide stock room assistants to the correct location  [6]   The key benefits of this technology would be; quicker processing and enhanced stock accuracy, thereby improving availability of stock and the level of customer satisfaction. Another possible improvement could be directed towards their gaming sector; as this is one of the areas they do not perform well in. They could do this by adopting a similar strategy to gaming stores like; Gamestation or Granger games. Which will include a trade in system for games and the value of the trade in(s) would be deducted from their chosen purchase from the Argos stores. Argos could then go on to sell the traded in games. The key benefits of this adopted strategy would be; increased sales at Argos as many people who buy games would be more inclined to shop there, increased revenue and a larger share of the gaming market. Conclusion Overall, this organisation effectively utilizes technology for growth, stability and convenience for both Argos and its customers. Argos has gained competitive advantage over competitors by distinguishing itself on the basis of providing the best value for money for customers through the most convenient shopping experience  [7]  . Tesco was one of the first organisation giants to integrate its already existing chain of supermarkets with a virtual online one, Argos uses the similar strategy but with a difference; convenience of reserving products online and collecting at the customers nearest retail store (there Click and Reserve service). The dominance and success of Argos (and other organisations like Tesco and Amazon) are a result of each of them applying their own unique shopping experience  [8]  . Argos is popular and successful because it is focused around meeting the customers needs. By incorporating new technologies, Argos continues to provide the methods that are most appropriate to the modern-day retailing experience.

Understanding the Social Contexts in which Art Works are Created :: essays papers

Understanding the Social Contexts in which Art Works are Created When analyzing artwork, in any form, there are often times social contexts in which can be interpreted. Not always does the history behind the painting need to be revealed to fully understand the concept of the artwork, yet it is helpful in determining if the artwork is truthful in its representation. Although in analyzing artwork it is likely that there are drawbacks to considering the social context. To illustrate this point, I'm going to use the visual arts as my medium of choice. Understanding the social context can be an important tool. An advantage of knowing the history of the painting or sculpture can really enrich our knowledge, being in the 21st century, about some of the social periods from previous times. It can demonstrate how traditions were carried out, how they had an impact on the different social classes. It's a visual teaching aid of a sort. Even in the time period of which the artwork was created can be used as a tool to show how the life was in different parts of the world. It was also used as a hammer in the realist movement to show the upper classes that life for the poor was horrible. The visual arts is the only medium in which the pictorial image creates a universal language in which anyone, regardless of nationality or social class can interpret. The text which is created by this language often creates a context which is left open to interpretation. Contexts are created by the artist, critics, judges, the public, essentially, any one who views the work and forms an opinion relating to it. The contexts stem from subject or content of an artwork, and are usually facts regarding the content. Yet, the contexts almost always have backgrounds themselves, therefore making the original contexts, texts. This will be more clearly illustrated later. The chain is seeming to be a never ending process. There are always more conditions to the previous ones. All context, therefore, is in itself, textual. This concept of all context in itself textual i s a post-structuralist strategy. A man named Derrida is a man who has developed this idea that the post-structuralist concept of every statement made, can be interpreted in infinite ways, with each interpretation triggering a range of subjective associations. Every statement has an association, therefore it's a sort of domino effect.

Chronicle of a Death Foretold Essay -- Chronicle of a Death Foretold V

Chronicle of a Death Foretold The type of violence portrayed in Chronicle of a Death Foretold is more of an honor killing, in which two innocent young men feel pressured by society to become violent, instead of their own intentions. The standards and expectations of the society and their own mother who summoned them with the problem expected them to take care of the situation and regain their sister's honor. The kind of violence seen in Billy Budd differs in that it is a regulatory measure meant to keep order and obey the rules of a society and an institution. While both acts of violence are not the pure testosterone driven raging acts seen in modern day news broadcasts, they differ in that they also show a background of honest premeditation. Both were committed for very serious, purposeful reasons of which the murderers knew the full weight of their actions and that was exactly what they intended. In both novels, the murder committed took away a good person's life, while to many witnesses and accomp lices there was a shadow of doubt as to the good intentions and reasoning behind these deeds. The misguided intentions began in Marquez's novel witht he arrival and objectives of Bayardo San Roman. He thinks he deserves a "perfect" bride and has come to this small Caribbean town to find her. Based on looks he picks Angela Vicario, without even knowing her or spending time alone he wants to spend his life with her. This kind of egotism and obvious materialism demonstrates that Bayardo wants Angela based on her looks and "pure" reputation that there are "no better-reared daughters" than the Vicario ones (Marquez 31). She personally means nothing to him, and he wants her for all of the wrong reasons. He is able to... ...to happen, regardless of a moralist’s sense of justice and human rights. Their job was to serve Britain in her Navy during the time of Napoleon, regardless of the personal infringements on the liberties of the crew. Those were minor in comparison to the safety of Britain and her King. The sense of regret and shadow of doubt which lingers after each of these murders, Billy Budd’s execution and the murder of Santiago Nasar, indicates injustice of the system and special circumstances. If the Vicario brothers did not live in a time when all felt it was their â€Å"duty† to find Angela’s â€Å"seducer,† then they would not have been compelled to commit the act they did. If Billy Budd was not at sea during a time of serious mutinies and heightened rebellions worldwide, the same atmosphere would have allowed him more justice and time for a complete trial, perhaps on land.

The Existence of a Monopoly and Public Interest Essay -- Monopolies Ec

The Existence of a Monopoly and Public Interest A monopoly is defined as the sole supplier of a good or service with no close substitutes in a given price range. A pure monopoly will therefore have a 100% market share i.e. the firm is the industry. They exist and can only remain as monopolies if there are high barriers to entry to the industry. In the case of a natural monopoly, economies of scale are so large that any new entrant would find it impossible to match the costs and prices of the established firm in the industry. Other barriers to entry include legal barriers such as patents, natural cost advantages such as ownership of all key sites in the industry, marketing barriers such as advertising, and restrictive practises designed to force any competition to leave the market. In this market structure it is also assumed profits are maximised and there is consumer rationality. Traditionally monopoly is thought to be a potentially harmful market structure with unwelcome consequences for the consumer and the economy. Competition has always therefore been seen to be desirable. It could be said therefore to be against the public interest. However there are arguments not only against monopolies but also for their existence. One of the main arguments against monopolies is that they raise prices, restrict output and therefore exploit consumers. This is because the neo-classical theory of the firm assumes that a monopolist will maximise profits which means it will produce where MC=MR. The equilibrium profit maximising level of output will therefore be where MC-MR. This is shown below: The diagram above shows the firm will produce the quantity Qe and will charge the price Pe. As the monopolist above is... ...s to large firms in the economy. Should it split them up or promote such firms. Competition policy therefore reflects the attitude towards monopoly. At the moment the UK has a pragmatic approach where monopoly can be good or bad. I t uses the monopolies and mergers commission to use a case-by-case approach. Competition policy is a government policy to influence the degree of competition in individual markets within the economy. Governments can also attempt to correct market failure caused by monopolies by taxing supernormal profit away, set maximum price levels, subsidise production, nationalise the industry, break it up or reduce entry barriers. In the past economists have generally come out against monopolies and in favour of competitive markets. However, this is clearly not conclusive as monopolies have many potential advantages and disadvantages. The Existence of a Monopoly and Public Interest Essay -- Monopolies Ec The Existence of a Monopoly and Public Interest A monopoly is defined as the sole supplier of a good or service with no close substitutes in a given price range. A pure monopoly will therefore have a 100% market share i.e. the firm is the industry. They exist and can only remain as monopolies if there are high barriers to entry to the industry. In the case of a natural monopoly, economies of scale are so large that any new entrant would find it impossible to match the costs and prices of the established firm in the industry. Other barriers to entry include legal barriers such as patents, natural cost advantages such as ownership of all key sites in the industry, marketing barriers such as advertising, and restrictive practises designed to force any competition to leave the market. In this market structure it is also assumed profits are maximised and there is consumer rationality. Traditionally monopoly is thought to be a potentially harmful market structure with unwelcome consequences for the consumer and the economy. Competition has always therefore been seen to be desirable. It could be said therefore to be against the public interest. However there are arguments not only against monopolies but also for their existence. One of the main arguments against monopolies is that they raise prices, restrict output and therefore exploit consumers. This is because the neo-classical theory of the firm assumes that a monopolist will maximise profits which means it will produce where MC=MR. The equilibrium profit maximising level of output will therefore be where MC-MR. This is shown below: The diagram above shows the firm will produce the quantity Qe and will charge the price Pe. As the monopolist above is... ...s to large firms in the economy. Should it split them up or promote such firms. Competition policy therefore reflects the attitude towards monopoly. At the moment the UK has a pragmatic approach where monopoly can be good or bad. I t uses the monopolies and mergers commission to use a case-by-case approach. Competition policy is a government policy to influence the degree of competition in individual markets within the economy. Governments can also attempt to correct market failure caused by monopolies by taxing supernormal profit away, set maximum price levels, subsidise production, nationalise the industry, break it up or reduce entry barriers. In the past economists have generally come out against monopolies and in favour of competitive markets. However, this is clearly not conclusive as monopolies have many potential advantages and disadvantages.

Closed Head Injury

Closed Head Injury Case Study Y. W. is a 23-year-old male student from Thailand studying electrical engineering at the university. He was ejected from a moving vehicle, which was traveling 70 mph. His injuries included a severe closed head injury with an occipital hematoma, bilateral wrist fractures, and a right pneumothorax. During his neurologic intensive care unit (NICU) stay, Y. W. was intubated and placed on mechanical ventilation, had a feeding tube inserted and was placed on tube feedings, had a Foley catheter to down drain (DD), and had multiple IVs inserted. He developed pneumonia 1 month after admission.Closed Head Injuries: Closed head injuries result from a blow to the head as occurs, for example, in a car accident when the head strikes the windshield or dashboard. These injuries cause two types of brain damage. 1. Define the term primary head injury. A primary head injury (or primary impact) is also known as a â€Å"coup injury. † The injury occurs under the site of impact with an object such as a hammer or a rock. The brain strikes the skull after the head strikes the object of impact (Lewis, et al, Fig 57-14). This is the site of the direct impact of the brain on the skull.Often there is edema around the site of impact. 2. Define the term secondary head injury. The secondary head injury is also known as contrecoup injury occurs on the side opposite the area that was impacted. These injuries tend to be more severe and overall patient prognosis depends on the amount of bleeding around the contusion site (Lewis, et al, 1425). Often it is the secondary brain injuries that show few initial symptoms and then have serious side effects days to weeks later. 3. What is normal intracranial pressure (ICP), and why is increased ICP so clinically important?Normal intracranial pressure ranges from 5 to 15 mm Hg. A sustained pressure above the upper limit is considered abnormal. Pressure changes in the brain effect the brain’s compliance. Complianc e is the â€Å"expandability of the brain† With low compliance, small changes in volume occur and result in greater increases in pressure. Elevated intracranial pressure is clinically significant because â€Å"it diminishes CPP, increases risks of brain ischemia and infarction, and is associated with a poor prognosis† (Lewis, et al, p. 1425-1427). 4. Identify at least five signs and symptoms (S/S) of increased ICP. signs and symptoms of increased ICP are †¢Decreased LOC (level of consciousness) †¢Respiratory problems (maintaining a patent airway is critical in the patient with increased ICP. Pt is at increased risk of airway obstruction (Lewis, et al, p. 1434). †¢Elevated systolic BP due to ischemia and pressure on the brainstem. †¢Bradycardia due to the ischemia and pressure on the brainstem as well. †¢Pulmonary edema due to increased sympathetic activity as a result of increased intercranial pressure. 5. List 4 medication classifications that the ICU nurses could use to decrease or control increased ICP.Some of the medications that the ICU nurses could use to decrease or control increased ICP would be: †¢Opioids (morphine sulfate and fentanyl) †¢IV anesthetic sedative propofol (Diprivan) to manage anxiety and agitation. †¢Vecuronium (Norcuron), cisatracurium besylate (Nimbex): nondepolarizing neuromuscular blocking agents: achieve complete ventilatory control in the treatment of refractory intracranial hypertension. (These agents paralyze muscles without blocking pain or noxious stimuli, therefore they are used in combination with sedatives, analgesics, or benzodiazepines (Lewis, p. 436)). †¢Dexmedetomidine (Precedex): alpha-2 agonist; used for continuous IV sedation of intubated and mechanically ventilated patients in the ICU setting for up to 24 hours. †¢Benzodiazepines are usually avoided in the ICU in management of the patient with increased ICP because of the hypotensive effect and long hal f-life. (Lewis, et al, p. 1436). 6. List 8 nursing measures that the ICU nurses could use to decrease or control increased ICP. * Maintain the patient in the head-up position. Elevation of the head of the bed reduces sagittal sinus pressure, promotes drainage from the head via the valveless venous system through the jugular veins, and decreases the vascular congestion that can produce cerebral edema† (Lewis, et al, p. 1436) * Position the bed so that it lowers the ICP while optimizing the CPP; not above 30 degrees. * Turn the patient with slow, gentle movements. Rapid changes in position may increase ICP. * Avoid extreme hip flexion—this risks raising intra-abdominal pressure which increases ICP. Turn pt every 2 hrs (minimum). * Protect the patient with ICP from self-injury with adequate padding on the bed.Because of likelihood of decreased LOC, confusion, agitation, and the possibility of seizures increase the risk for injury. * Be prepared to explain situations to fam ily and caregivers and the patient. With increased ICP, anxiety is likely and the prognosis can be distressing. By providing short, simple explanations that are appropriate, it allows the patient and the caregiver to acquire the amount of information they desire (Lewis, p. 1438). * Decorticate or decerebrate posturing is a reflex response in some patients with increased ICP. The nurse can use turning, skin care, and even passive range of motion. Monitor fluid and electrolyte status. Disturbances can have an adverse effect on ICP. Closely monitor IV fluids with the use of an accurate intravenous infusion control device or pump; monitor intake and output and daily weights. (Lewis, et al, 1437) * Perform neurological assessments every hour. 7. Y. W. ’s medication list includes clindamycin 150 mg per feeding tube q6h, ranitidine (Zantac elixir) 150 mg per feeding tube bid, and phenytoin (Dilantin) 100 mg IV piggyback (IVPB) tid. Indicate the reasons for each. †¢Clindamycin 1 50 mg per feeding tube q6h: Treatment of respiratory tract infections; to treat Y.W. ’s pneumonia. (Skyscape, 2012). †¢Ranitidine (Zantac elixir) 150 mg per feeding tube BID: Used to treat and prevent stress ulcers (stress-induced GI bleeding in critically ill patients). Due to head injury, overstimulation of the vagus nerve from TBI. †¢Phenytoin (Dilantin) 100 mg IVPB TID: Used to treat and prevent tonic-clonic seizures and complex partial seizures. Seizure is seen in 5% of patients with a non-penetrating head injury (Lewis, et al, p. 1445). 8. A STAT portable chest x-ray (CXR) is ordered after each central venous catheter (CVC) is inserted.According to hospital protocol, no one is permitted to infuse anything through the catheter until the CXR has been read by the physician or radiologist. What is the purpose of the CXR, and why isn’t fluid infused through the catheter until after the CXR is read? The chest x-ray confirms the proper placement of the central venous catheter. If fluid is infused through the catheter before a CXR has confirmed placement, the patient is at high risk for systemic infection or possible pneumothorax (which would occur if the catheter were to be entered into the lung by mistake instead of the superior vena cava).CASE STUDY PROGRESS Y. W. spent 2 months in acute care and is now on your rehabilitation unit. He follows commands but tends to get agitated with too much stimulation. His tracheostomy site is well healed, and the pneumonia is finally resolving. He is still receiving supplemental tube feeding and has some continued incontinence of both bowel and bladder. Y. W. has a supportive group of friends who are students at the university; several of them are also from Thailand. 9. Y. W. ’s latest lab results are as follows: Na 149 mmol/L, K 4. mmol/L, Cl 119 mmol/L, total CO2 21 mmol/L, BUN 12 mg/dl, creatinine 1. 2 mg/dl, glucose 123 mg/dl, WBC 15. 4 thou/cmm, Hgb 14. 9 g/dl, Hct 36. 4%, platelets 140 t hou/cmm. Are any of these of concern to you, and what would you suggest to correct them? I am concerned about 3 of the labs. Sodium: high (increased); hypernatremia; high sodium levels cause neurologic problems including intense thirst, lethargy, agitation, seizures, postural hypotension, weakness, and decreased skin turgor. Chloride: High, increased; High chloride levels occur because of increased sodium levels.It is important to correct the sodium level so the chloride level can follow suit. Again, hypernatremia and the nurse must watch out for dysrhythmias, HTN, and impaired mental response. –> Correcting increased sodium would include: Hypotonic saline (via IV) and 5% dextrose in water (IV)- (Lewis, et al, p. 312) WBC count:15. 4 increased; this increased level indicates infection. This can be attributed to the patient’s diagnosis of Pneumonia. Administration of appropriate antibiotics will help bring the white count back to a normal level. 0. Are you surprised by Y. W. ’s agitated behavior? Explain. YM’s agitation is of no surprise. Patients that have head injuries often express agitation easily. Increased intracranial pressure and the head injury the patient has experienced can cause agitated behavior to arise. It is imperative for the nurse to use interventions to decrease the agitated behavior which can further lead to feelings of anxiety. Providing a calm and non-stimulating environment, free of stressors, is a good way to do this (Lewis, et al, p. 1438).Also, the nurse can elevate the bed 15-30 degrees with appropriate oxygenation applied. 11. Outline a general rehabilitation plan for Y. W. based on the above data. The rehab plan will include -physical therapy- working on gross motor skills, walking, sitting, transferring, and range of motion -occupational therapy- aids in completion of ADLs and learning of new techniques to complete these tasks of daily living -nutrition- proper nutrition to keep patient nourished and als o consuming enough vitamins/minerals/proteins to aide in healing. nursing staff- administer antibiotics, pain medications, and supportive care. -speech therapy- to evaluate and aide with swallowing, eating/drinking, and eventually verbal communication improvements. 12. Y. W. ’s mother has just arrived in the United States and speaks no English. What measures can be taken to facilitate communication between medical personnel and the mother? First and foremost the nurse should find out what language is the mother’s native language. Most people are unaware but it is not safe to assume there is one language that will apply to an entire country.Quite a few countries speak a language based on their village. The nurse will need to acquire an interpreter that will speak the language that best suits the mother. If the patient’s friends/classmates are around, they can also be used to aid in interpretation and communication between health care staff and family. 13. Y. W. à ¢â‚¬â„¢s mother will need a place to stay while in the United States. What can you do to facilitate the initial contact with the Thai community? Hopefully the other Thai students are around or could make a suggestion for the patient’s mother.I would also ask the social worker if they know of any thai-specific cultural centers in the area. I could check with the interpreter, and see if they have a lead. I would also google Thai community San Diego and see what I could find. 14. What special discharge planning considerations are there in this case? Discharge considerations for this patient will involve knowing where the patient is discharging to. The nurse will need to know if the patient is staying in the US and continuing with follow-up outpatient rehab with our facility and if not, then where will they be.The nurse and other members of the healthcare/rehab team need to educate the patient on his injury and what comes next for him in terms of rehabilitation. The nurse needs t o consider what modifications YM has made to his lifestyle post injury. Discharge planning should include an outpatient schedule for OT, PT and Speech (assuming he will stay here). Education for caregivers and family is also very important so that the patient has a support system available during the recovery and rehabilitation process.The patient will need to be sent home with any tools he will need for ADLs, with medications or supplements that are still necessary for recovery. If the patient is in need of special services or devices (i. e. wheelchair, ramps, vehicle to accommodate special devices, etc. ), a case manager should be sought out to ensure that these needs are met. References Lewis, et al, (2011). Medical-Surgical Nursing Assessment and Management of Clinical Problems. 8th ed. Vol 1. St Louis, Missouri: Mosby. Skyscape. (2010). Skyscape Medical Resources (Version 1. 9. 11) [Mobile application software]. Retrieved from http://itunes. apple. com/