Gastroesophageal reflux disease Essays

Gastroesophageal reflux disease Essays Gastroesophageal reflux disease Essay Gastroesophageal reflux disease Essay This essay will explore two case studies based around orthopedic and gastrointestinal nursing. Claire is a 61 year old female who has been admitted with a Tip/Fib fracture of her right leg and a left Coles fracture, with a past history of osteoarthritis and recently osteoporosis. Justine is a 33 year old male admitted with Castro esophageal reflux disease plus or minus peptic ulcer disease prepping for a gastropod and oscilloscope. Clinical presentations and nursing management as well as disease processes will be made evident throughout. (a) Arthritis is the common word used to describe inflammation of joints in the unman body. Osteoarthritis is the most common form of this, known for creating wear and tear. The physiology affects all joint tissues and in particularly, cartilage, causing structural and biochemical modifications before finally destroying. Most commonly affects weight bearing joints such as hips, knees, and spine but can affect others if previous injury or excessive st ress has occurred. (Possess et al. 2014) Osteoporosis is a complex condition in which the skeletal systems bone strength is compromised leading to increased fragility and bone fractures. This occurs when bones lose minerals quicker than the body can replace them, for example, calcium. Therefore bone density and strength decreases, holes form and bones are susceptible to breakage. (Becker, 2008) (b) Examples of modifiable risk factors include dietary intake involving varied fruit and vegetables for example a calcium rich diet including dairy products or spinach. Other methods of obtaining sufficient calcium include supplements in the form of tablets. Increasing the level of physical activity such as weight bearing exercises and activities to strengthen bones is very important and reduces the risk of development or disease progression. Cache, 201 2) Non-modifiable risk factors for osteoporosis include advanced age in both men and women with an increased risk factor associated with genetics and family history. All ethnic groups are effected but in particularly European and Asian ancestries are predisposed. People who have had a bone fracture are twice a likely to have another fracture when compared with someone of the same age and sex. Cache, 2012) c) Clinical manifestations in relation to Claimers diagnosis of Osteoarthritis in both her hip and knees would have most commonly included pain and stiffness of the joints. Muscle weakness especially in the knee on ambulation as well as swelling of the joints may be present. Reduced range of motion and creaking of the joints may have been noted on further assessment. (Steinberg et al. , 2014) d) Osteoporosis is often not manifested until a fracture occurs however, Claire was diagnosed before her current fractures presented. : She may have accessed health services recently with a minor fracture and ongoing pain or possibly reduction in her height. Back pain is a classic symptom possibly affecting Claire, fractures also occur more easily when osteoporosis is present Becker, 2008) e) The post-operative care of a Coles fracture includes elevating the wrist above the elbow and encouraging Claire to make passive movements with her fingers and thumb regularly. This reduces edema and promotes venous return as well as rotating the shoulder to prevent stiffness and contractors. Apply ice regularly for the first 24 hours to reduce pain and swelling and commence half hourly neuromuscular observations for the first four hours post operatively to monitor for any signs of post-operative complications such as pain, numbness and poor capillary return. (Brown and Edwards, 012) Claimers Tip/Fib fracture with external fixation will have half hourly neuromuscular observations for the first four hours to monitor for post pop complications. These may include a fat embolism, severe pain, redness and swelling or numbness for example. Monitor external fixation sites for signs of infection and compartment syndrome whilst assessing neuromuscular observations or if Claire is complaining of pain and pressure in her leg. (Brown and Edwards, 201 2) f) Immediately assess neuromuscular observations to see if the pain is associated with numbness or tingling, capillary return and the amount of sieve movement present when compared with previous assessments. Administer pain relief, possibly OMG of Undone orally or 2. OMG of Morphine subcutaneously dependent on PR medications charted and allergy status. Notify doctor to review quickly as post pop complications such as acute carpal tunnel syndrome or complex regional pain syndrome may be occurring. Monitor general observations to ensure all aspects of the patients current State are noted. Median nerve compression may also be present due to the surgery that has been completed approximately eight hours earlier. (Alter, 008) g) Acute carpal tunnel syndrome occurs when the median nerve gets squeezed inside of the carpal tunnel located in the wrist, also known as nerve entrapment. The carpal tunnel is a channel formed by the wrist bones arranged in a circle like shape. Nerves and blood vessels pass through the channel from the wrist to the hand. Anything that effects pressure inside the carpal tunnel can cause compression of the median nerve, in turn leading to carpal tunnel syndrome. Symptoms include pain, numbness and tingling known as median enumerator. Open decompression of the carpal tunnel is he treatment used in an acute carpal tunnel syndrome case. (Never and Alias, 201 2) Complex regional pain syndrome, also known as CROPS is a chronic pain condition which Often affects one Of the limbs, usually after an injury or trauma especially triggered by a fracture. CROPS is thought to be triggered by injury to, or a glitch in the peripheral and central nervous systems either occurring when damaged by the fracture and after surgery. CROPS is described as sustained or extreme pain with symptoms occurring from mild to dramatic changes in skin color, temperature or swelling in the area affected. (Harden et al. 2013) 2 (a) Castro-esophageal reflux disease also known as GORED, is a disorder whereby the reflux of gastric contents is forced into the esophagi causing complications and symptoms reducing quality of life. Usually caused by changes in the barricade between the stomach and the esophagi. This includes abnormal relaxation of the lower esophageal sphincter, which would normally hold the top of the stomach closed. Therefore forcing gastric juices upwards and can also be caused by a withal hernia. Common symptoms of GORED include persistent heartburn and acid regurgitation which may be relieved by antacid medication. Pain in the chest may also occur along with hoarseness in speaking and difficulty swallowing. Morocco, 2008) A peptic ulcer is known as a break or an ulceration in the protective mucosa lining of the stomach or duodenum. Factors that cause peptic ulcers include, gastric juices and medications listed as Nan-steroidal anti- inflammatory drugs or Englands which aggravate the mucosa lining. Symptoms related to this disease include epigenetic discomfort, loss of appetite and weight loss. An ulcer can cause structural changes such as penetration through the muscular wall of the stomac h or duodenum into an adjacent organ for example the pancreas or liver. Perforation can also occur most commonly on the surface of the duodenum creating an opening in the free space of the abdominal cavity. (Rumanians and Salinas, 2007) b) Epigenetic pain and reflux are a common clinical manifestation which Justine has been experiencing in relation to suffering with recurrent bouts of GORED more common than usual. He is relieved with the use of over the counter antacids. Intolerance to fatty foods may have recently occurred as Justine regularly consumes this as well as having returned from overseas ill. Stress ay be playing a role due to Justine obtaining a new promotion with increased stress in his life. (Rumanians and Salinas, 2007) c) The common causative agent of peptic ulcer disease is the continual use of non-steroidal anti-inflammatory drugs also known as Englands. Especially when taken on an empty stomach can cause ulceration. Englands are a class of analgesic medication used to reduce pain, fever and inflammation and can cause sub mucosa erosion. (Blair and Belt, 2006) Proton pump inhibitors reduce gastric acid secretion by inhibiting certain enzymes called the proton pump in the parietal cells. In simple terms, proton pump inhibitors decrease the production of acids by blocking the specific enzyme in the wall of the stomach which is in charge of producing these acids. The reduction of acid decreases the production Of ulcers and allows any present ulcers in the esophagi, stomach or duodenum to heal effectively. Examples of these drugs include Pantaloon and Comparable relieving ulceration and reflux in peptic ulcer disease. (Tasmania and Havana, 2010) 3 (a) In preparation for a bowel related surgery or oscilloscope, oral bowel preparation will be administered slowly or if not tolerated, a instigators tube ay need to be inserted. The nurse will monitor all input and output on a fluid balance chart, the patient may be nil by mouth or on clear fluids. All stools will need to be visualized in a bedpan until clear, rectal enemas may be ordered by the doctor as a secondary method to clear out faces. The patient will be showered, placed in a gown, measured for compression stockings also known as DEEDS and paper underwear. All theatre paperwork will be filled out in relation to procedure, correct identification labels by two, labeled in red if allergies are present. Baseline observations and weight will be written on anesthetic chart prior to handover to theatre staff. Any pain issues will be managed with analgesia prior to procedure dependent on fasting status and type of procedure and intravenous therapy may be ordered. (Rapier and Houston, 2006) (b) View blood and stool in the toilet and if significant, notify doctor to review patient immediately as this is not a normal occurrence and something sinister is likely to be occurring internally. Justinian back to bed and monitor his vital signs and maintain fluid balance chart. An increased heart rate and low urine output may indicate significant blood loss. Monitor for further uncontrolled rectal bleeding and commence Intravenous therapy (0. % Normal Saline) if ordered by the treating doctor prior to oscilloscope/ gastropod. This will replace any bodily fluids lost through bleeding, stools, urination and sweat. Recommence bowel prep if the doctor requests, so as to be prepared for scopes. (Grapnel, Burbank and Aboard, 2008) c) Half hourly observations of blood pressure, heart rate, temperature and o xygen saturation levels for two hours due to sedation during procedure. Maintain fluid balance chart, measuring all input and output and managing pain if occurring. Monitor for ongoing rectal bleeding, measuring and visually inspecting all stools in a bed pan. Monitor for signs of perforation such as abdominal cramps or distension. Patient is to remain nil by mouth until gag reflex returns, warm saline gargles can be used to relieve sore throat from gastropod. Monitor temperature as a sudden spike becoming febrile can indicate perforation. (Brow and Edwards, 2012) Conclusion: It can be seen throughout this case study the differentiating nursing care and assessment of orthopedic and gastrointestinal patients. Pathologically of disease processes and clinical presentations related to understanding signoras and treatment is evident.

6 Ways to Pay for Private School

6 Ways to Pay for Private School Attending a boarding school isnt cheap, we all know that. And today, many tuitions can cost a family as much as $70,000 a year (now multiply that by four years). Most private schools seem to be topping out around $45,000 to $55,000 a year, but some go well above that amount. Day school tuition typically runs about half that cost, or even less, depending on where you live. Even the primary grades cost a fortune these days. Paying for a private school education requires tremendous sacrifice for most parents. So how do you do it? How do you manage to pay for private school  tuition over the course of your childs education? Here are six ways you can manage those large tuition bills. Earn Cash Back on Tuition Payments Most schools expect payment of fees in two installments: one due in the summer, typically by July 1, and the other due in the late fall, typically by the end of November of the current academic year. Other schools may do their billing by semester or term though, so it varies. But, a little tip that not many families know is that schools will permit payment with a credit card. Simply make your tuition payment twice a year on a credit card with a rewards program, like a cash back card or one that will earn miles,  and then make your regularly scheduled monthly payments on the card. Lump Sum Discounts Schools always hate chasing down families who are late on their bills, which can have some negative results. But if you work with the school and pay your bill upfront, its often met with a discount. If youre able to pay your tuition bill in full by July 1, the school may offer you a  five to ten percent discount on the overall amount. Discount plus earning cash back with credit card payments? That sounds like a deal to me.   Tuition Payment Plans Not everyone can make lump sum payments and use a credit card to do so. For those families, there are still plenty of options. Most schools participate in tuition payment plans which are offered by outside providers, if not the school itself. The way these plans work is that you pay one-tenth of the expenses each month to the payment plan provider, which in turn pays the school on an agreed basis. It can be a real boon to your cash flow by allowing the payments to be spread equally over a number of months. The schools like the fact that they dont have to manage your billing. Its a win-win.   Financial Aid and Scholarships Almost every school offers some form of financial aid. You have to file an application for aid with the school and also file a standardized form, such as the Parents Financial Statement. The amount of aid which you can reasonably expect depends to a great extent on the size of the schools endowment, how much the school really wants to recruit your child, and how the school allots its scholarships. Several schools now offer a virtually free education if your family income is below $60,000 to $75,000 annually. So, if you need financial aid, see what the various schools on your short list can offer. Finally, be sure to ask around in your community. Many civic and religious groups provide scholarships. Loans Just like in college, loans are an option to pay for private school, though these are usually in the parents names, while college loans are often in the students names. Families have the ability to borrow against their assets to pay for private school education. There are also some specialized educational loan programs available, and your private school might offer or contract with a loan program, as well. It is always a good idea to consult your tax adviser and financial planner before making a major financial decision such as this. Company Benefits Many major corporations will pay for tuition and related educational expenses for dependent children of expatriate employees. So if you are posted to Belgium tomorrow, the main issue you will face is getting your children into the local international school. Fortunately for you, the tuition expenses will be paid for you by your company. Ask your Human Resources department for details. Edited by  Stacy Jagodowski

International retail marketing Essay Example | Topics and Well Written Essays - 2500 words

International retail marketing - Essay Example As per the traditional concept, the marketing mix has four major components i.e. product, price, promotion and place. However, with emerging complexity of servicing industry, many academics have identified additional three Ps in marketing mix for services which are people, process and physical evidence. Moreover, the concept of marketing mix has become more specific and consumer centric for better business management by creating value for the consumers. Hence, four Cs i.e. consumers, cost, communications and convenience is more relevant for effective business management. Office Shoe is a popular shoe retailer chain of UK and it is planning to expand its marketing in the Swedish retail market. In order to successful market entry and for long term growth, it is very necessary to analyse the multiple macro-economic and consumers related factors. Considering these factors, Office Shoe should develop a set of plausible marketing mix strategies. Identification of culture and features of th e prevailing consumers is the priority of the retailer. Moreover, it also needs to restructure its business organisation through the method of retailing which is the best as it is very helpful in figuring out the necessary areas for retail business development. Introduction The task of handling the strategic business management has changed significantly due to a number of factors. Globalisation, increasing international trade activities has upgraded the business management process. The post-modern organisations have realized the importance of distinct management structure and strategic process for different types of business. For example, service industry and manufacturing industry have their different value chain process and organisational structure which required a focused and specific management system. Moreover, the interactions with customers are also very different as in most of the cases service providers have a direct interactions with their consumers; whereas, the manufactu ring organisation have very limited scope in this respect (Greasley, 1999, p.2). However, the core essence of the business management remains the same i.e. to maximise the wealth of stakeholders through value creation method. This paper will attempt to present major aspect of international retail marketing focusing on the structure of domestics and international marketing mix of retailing business. The discussion will involve the Office Shoes, a popular U.K.-based domestic shoe retailer. This shoe retail chain store was established during 1981 and experienced an extreme successful business growth all over UK. It is present in more than 15 local regions of UK (Office Shoe-a, n.d.). It offers more than 100 ranges of international and domestic shoe brand like Adidas, Reebok, Nike, Converse, Puma, Swedish Hasbeens and many more for males, females as well as kids. Besides, it also offers leather accessories like bags, belts etc tots female consumers (Office Shoe-b, n.d.). This paper will present a set of proper international marketing mix for the Office Shoe’s expansion in Sweden’s market. Marketing Mix Marketing mix is a celebrated term and theory in the field of marketing management practises. With constant changes in management theories practises, many new concepts have been incorporated in the concept of marketing mix. Primarily, marketing mix consists of four basic elements of marketing i.e. product, price, promotion and place. It is the core essence and requirement framing effective marketing strategies. Frank has described that marketing mix