Postoperative Pain Management Case Study

Postoperative Pain Management Case Study Introduction Postoperative pain management is the main issue in the case study of Josie Elliot, a 26 years old woman who had a surgery for internal fixation of fractured right wrist- the radius and scaphoid bones.Therefore, this assignment mainly describes the importance of pain management in post-operative care and also discusses the possible effects of unrelieved pain in the case of Josie Elliot. This writing further explains the process of making clinical judgement using the Tanners Model (2006) and discusses its application in the management of Josies postoperative pain management. This assignment also includes three progress notes to document the main clinical events that occurred in three different shifts while managing Josie’s pain. Importance of pain control in post-operative care and the potential effects of uncontrolled pain for Josie Elliot:(298 words) Managing postoperative pain is an essential component of the postoperative care for various reasons. According to Australian and New Zealand College of Anaesthetists (2013), effective management of post-surgery pain may reduce the incidence of postoperative morbidity and facilitate earlier discharge from hospital. Some other advantages of effective post-surgery pain control include an increased patient comfort and satisfaction, earlier mobilisation, few pulmonary and cardiac complications, a reduced risk of deep vein thrombosis, faster recovery with less possibility of the developing neuropathic pain and reduced cost of care (Ramsay 2000). Furthermore, the information-subjective and objective, collected during the post-surgery pain management also supports the plan of care using the evidence based nursing practice (Vaughn 2007). In contrast, unrelieved acute pain can prolong hospital stay,delay return to normal activity, lower satisfaction with care and give additional financial burden (Ritchey 2006). This can have long-lasting effects on physical, emotional, social and spiritual state of the person involved and his or her family and carers. In the case of Josie, who is right handed will need assistance with self-care. She may feel the loss of her autonomy and she may be worried if she can ever do soccer and swimming again. There are also some adverse physiological effects of uncontrolled pain. A patient could suffer from include tachycardia, hypertension, hyperventilation, decrease in alveolar ventilation, transition to chronic pain, poor wound healing, and insomnia (Shoar, Esmaeili Safari 2012). Unrelieved pain also causes stress( ) and in response to the stress, hormones-cortisol and glucagon are released. These hormones can lead to numerous problems including insulin resistance, hyperglycemia and postoperative complications (Dunwoody et al. 2008). In the case of Josie, who is a diabetic, the consequences of insulin resistance and hyperglycemia can not be overlooked because studies indicate that patients with poorly-controlled diabetes experience increased levels of postoperative pain and need higher doses of morphine to achieve optimal pain relief (Holt 2012). Tanners Clinical Judgement Model explains the way nurses make a clinical judgement. Noticing, interpreting, responding, and reflecting are the four pillars of clinical judgement. Noticing is the process of becoming conscious of the situation. Interpreting is making sense of what is noticed and selecting a course of action. Responding is the process of acting on the situation while beginning the first phase of reflecting on the action and the results of the action to allow for modifying the intervention. Reflecting includes both reflecting in action and reflecting on action, allowing the nurse to make sense of and learn from the experience (Tanner 2006). Clinical judgement is recommended when deciding on an intervention to manage postoperative pain being mindful of factors such as side effects, risk of adverse events and patients needs and preferences (Chen 2013).The management of postoperative pain by nurses includes assessment of pain and decision making in regards to the need and type of pain relief. Nurses, where allowed are also involved in prescribing analgesia for pain management (Chen 2013). Noticing Noticing is the skill that develops over time and is amalgamation of background knowledge, contextual knowledge, and knowing the patient. This synthesis creates expectations about what the nurse is likely to encounter in the patient situation. Background knowledge includes comprehensive knowledge of appropriate physiology and pathophysiology, pharmacology, psychology, standards of practice, and past experiences. Contextual information is very useful in promoting early recognition. Finally, knowing the patient and the patients typical pattern of behaviour allows the nurse to notice when something is happening. For example, if the nurse is caring for an elderly patient who has been alert and oriented but is now drowsy and responds unclearly to the questions, the change in the way the patient responds can alert the nurse to potential complications. In the case of Josie, after the surgery, all her observations-Blood Glucose Level, vital signs and neurovascular limb obs are returning to n ormal, however her pain is increasing. Her pain rating has increased from â€Å"no pain† at 1100 hours to â€Å"some discomfort in the wrist’† at 1600 hours. She complains of â€Å"heavy aches† at 1800 hours and rates the pain 6 out of 10 on pain scale. Interestingly, she was given IV morphine 10 mg at recovery at 1030 hours. Interpreting Interpreting may include analytical, intuitive, or narrative reasoning. The nurse makes a conclusion based on an initial grasp of the situation and continues to refine this understanding while gathering additional data, acting to remedy the problem, and watching the results of his or her actions. The process of interpretation may require further patient assessment and may lead to interventions that may or may not relieve the problem. The patients response to the interventions may trigger further noticing and assessment. For example, if the patient complains of chest pain and the nurse knows that the patient had heart surgery the previous day, the nurse may interpret the pain as postsurgical pain and medicate the patient for that while continuing to monitor for signs such as relief or non-relief of pain. In the case of Josie, the pain is localised to her wrist and it is increasing. An experienced nurse can interpret the reason for increasing pain as inappropriate dosing interval of an algesia because she has not been provided with any analgesia since she had IV morphine at 1030 hours at recovery. Responding The third process in clinical judgement is responding. Responding is based on the nurses interpretation of what was noticed as well as on planned assessments. The nurse determines a course of action and implements the plan while watching patient responses. As the situation becomes clear, the nurse will modify actions or reevaluate the situation if the desired results are not obtained. In the case of Josie, a prudent nurse should administer IV morphine 5 mg immediately after confirming that she has not been given any analgesia since 1030 hours. This will rapidly decrease her pain and make her comfortable. Then half an hour later the pain level should be reassessed. She should be given paracetamol 1gram 6 hourly and tramadol 100 mg 8 hourly until she does not complain of pain and swelling disappears. This approach of combining opioid and one or more drugs such as paracetamol and tramadol to relieve pain is called multimodal pain relief. This combination may improve pain relief and redu ce the side effects by reducing the need for opioids such as morphine (Mayo Clinic 2014). Reflecting The fourth process in clinical judgement is reflecting. Reflection occurs both during the action and afterwards. Reflection during the action is known as â€Å"reflection-in-action† and it helps nurses to evaluate the effectiveness of their nursing intervention by reading the response of the patient and improve the response in the moment. Reflection afterward is known as â€Å"reflection-on-action† and it gives the nurse an opportunity to think about how the outcomes could have been improved. This awareness prepares nurse to learn from his or her own experiences. Learning from the experience can then be integrated with the nurses background knowledge and be available for use in future situations. In the case of Josie, a prudent nurse will â€Å"reflect in action† by combining two or more analgesics and References Chen, Z 2013, Post-operative Pain Management: Nursing Interventions, systematic review, viewed 26 August 2014, . Shoar, S., Esmaeili, S. Safari, S. 2012, Pain Management After Surgery: A Brief Review, Anesthesiology and Pain Medicine, vol. 1, no.3, pp. 184-6 Dunwoody et al. 2008, Assessment, Physiological Monitoring, and Consequences of Inadequately Treated Acute Pain,Pain Management Nursing, vol. 9(1), pp. 11-21 Holt,P. 2012, Pre and post-operative needs of patients with diabetes,Nursing Standard, vol. 26, pp. 50-6 Mayo Clinic 2014, Pain medications after surgery, viewed 30 August 2014, http://www.mayoclinic.org/pain-medications/art-20046452> Ramsay, A.E 2000, ‘Acute postoperative pain management’,Baylor University Medical Center Proceedings, vol.13, no.3, pp: 244–7. Ritchey, R. M. 2006, ‘Optimizing postoperative pain management’, Cleveland Clinic Journal of Medicine, vol.73, no.1, pp. 72-6 Vaughn, F., Wichowski, H. Bosworth, G. 2007, ‘Does Preoperative anxiety level predict postoperative pain?’, AORN Journal, vol. 85, no. 3, pp. 589-90.

American Fast Food in Korea Essay

1. Base on market information for Asia Pacific, we can made conclusion that business future in Asian region has to have bright future. With 33% of the world’s GDP and 50% of its population, Asia has emerged as a rapidly growing force in the global economy. Due to the cultural diversity, regulatory controls, growing base of consumer power and its own set of business â€Å"rules,† the multinational corporations (MNCs) find it challenging to enter the Asian market successfully. Most MNCs are reassessing their existing strategies or formulating new strategies to sustain their growth (4). With regional exports exceeding $1. 3 trillion, the East Asia and Pacific region’s share of trade in GDP is the highest in the world. (Global Development. Finance Report. 2006). The economy of South Korea has grown in the last 35 years. Per capita GNP only $100 in 1963, exceeded $20,000 USD in 2005. South Korea is now one of the world’s largest economies (as of 2006, it is 14th in the world according to GDP). (2). If we will compare Korean market to East Asian countries (Exhibit 1 p. 12). From report I have strong understanding that mane fast-food market in any Asian countries is in big cities. Let’s check urban population level in all Asian countries. Based on Exhibit 1 we can clearly see that Korea has one of the best Urban Population level-total population level 47. 6 million and urban population is 82%. Check GDP and GNI level. We can see that Korean level one of the highest in the Asia. Nominal GDP (2005 est. ): $811. 1 billion. GDP growth rate: 2003, 3. 1%; 2004, 4. 6%; 2005, 4. 0%. Per capita GNI (2004): $14, 162. (5). In 1997 Korea had some serious economic crises and faced sever difficulties. After some structural reforms in Korean government, economy starts to recovery. Already In 2001 Korea was 13th largest economy in the world with GNP of $398 billion. So based on all information from above I can make conclusion that Korea has good future and it is one of the most promising market in Asian region. 2. Porter’s Five Forces have become a yardstick for assessing industry profitability. They are†¦ ?Buyers’/customers’ power ?Suppliers’ power ?Rivalry among competitors ?Threat of new entrants ?Threat of substitute products I will try to analyze each one, for Korean fast food market. Buyers ‘power. The power of buyers is the impact that customers have on fast food industry. Buyers could be powerful in different circumstances. I believe that in our case we can say that buyers are concentrated. As I could explain earlier, main per cent of population in Korea are in the big cities. Its give us good idea that for fast food industry in this region will be easier to delivery product to the customers. Buyers purchase the significant proportion of output. Suppliers power. A fast food industry require raw material for there business-labor, components. It leads to buyer-supplier relationship between the fast food industry and the firms that provide it the raw materials used to create products. Suppliers are powerful if they are concentrated- it will be really expensive to switch the supplier. From another side suppliers are week if it will be many suppliers with standard product on the market Korean agriculture sector includes forestry and fisheries. National products are rice, vegetables, fruit, root crops, barley; cattle, pigs, chickens, milk, eggs, fish. About 20% of the land used for agricultural busyness (5). From here we can understand that for fast food companies will be easy to find or switch the suppliers without problems for there businesses. Threat of new entrants. The possibility that new firms may enter the industry also affects competition. In theory any firm should be able to enter and exit market. And if free entrance and exit exists, than profit always should be nominal. There are some barriers of entry. Easy to entry if: little brand franchise; access to distribution channels; common technology. On Korean market steal not allot firms with brand franchise. And it is big requirement in new choices for customers. It let us know that it will be easy to enter to the market. Threat of substitute products. Product price elasticity is affected by substitute products-as more substitute become available, the demand becomes more elastic since customers have more alternatives. A close substitute product constrains the ability of firms in an industry to raise prices. In our case we can see example of some firms, Lotteria and McDonalds, who easy change there recipes for Korean customers which needs more healthy national ingredients for there food. Rivalry among competitors. In pursuing an advantage over its rivals, a firm can choose from several competitive moves: changing prices; improving product; creatively using channels of distribution; exploiting relationship with supplier. For firm who will try to enter Korean market, I would say more realistic and more helpful move will be to improve products. Improving quality of materials, quality of services, and probably quality of food preparation technology (healthier environment), will be most important key to success on the Korean fest food market. 3. Urban Koreans eat out frequently. Fast paced lifestyles are driving Koreans to choose western-style fast-food, but healthy eating is a concern. These factors are driving a fast growing market for sandwich store franchising (3). Another important factor is that about 75%-80% fast food customers are young people whose age less than 20 year old. It is mean that â€Å"along with westernization of Korean taste, western chain gained in popularity†. In the past, people seeking a fast meal would have been satisfied by fast-food giants like McDonald’s or Burger King, but it is changing. Consumers are seeking different choices. This new requirements has opened doors for a steadily growing market for fresh and healthy sandwich businesses. Lotteria is a local hamburger franchiser and is the fast-food market leader in Korea. From 2002 to 2003 Lotteria experienced a sharp sales drop of 40%. However, a strong contrast was seen in the South Korean sandwich market, as its $41. 20 million1 market value in the second quarter of 2003 doubled to $82. 40 million in the fourth quarter. This dramatic growth is forecast to continue, and the anticipated market value for 2004 is $117. 71 million (3) Besides Lotteria, the local franchisers include Sandday, Sandpresso and Sand & Food. In response to the aggressive foreign companies, they are also coming up with strategies to secure their position within the market, and the competition is about to heat up. Based on all this information I would say that fast food business in Korea growing and this will continue until people need more choices. 4Globalization is the key to sustained growth for Yum Company! Brands, the world’s biggest quick-service restaurant company headquartered in the United States and managing five fast food brands – KFC, Pizza Hut, Taco Bell, A&W and Long John Silver’s. â€Å"Demand for fast food is rising because lifestyles are changing,’’ said Allan, who leads overseas operations outside of the U. S.and China, in a recent interview with The Korea Times. More Koreans are being time pressured than they were historically. This trend is happening here. The number of people eating ready made food is continuing to increase. ’’(Graham Allan, president of Yum! Restaurants International. 11. 06. 2006) (6). As a socially responsible company, the 51-year-old executive said Yum will provide more optional dishes to health-conscious consumers amid a well-being spree in the nation, but will not abandon its traditional concept of â€Å"great taste. ’’ Under his leadership, Allan said he will target an annual growth of 10 percent or more in operating profits. There are about 250 Pizza Hut delivery outlets in the nation, which are set to expand to over 400. Korea makes up about 5 percent of Yum’s international division sales, which amount to some $11 billion – half of the group’s overall system sales. If I were business consultant, I would recommend starting making money on Korean fast food market. The new trend is propelling growth in the franchising market. It is anticipated that the market will experience intense competition for the next couple years. New fast food companies should be able to take advantage of the situation and enter the market without much difficulty, while it is still at an early stage of development. Reference page: 1. http://www. iff. com/Internet. nsf/0/B7A5C7E9B662B52685256D02006683DA 2. http://www. answers. com/topic/economy-of-south-korea 3. http://ats. agr. ca/asia/3879_e. htm 4. www. berkeleyabc. org/2006/ 5. http://www. state. gov/r/pa/ei/bgn/2800. htm 6. http://times. hankooki. com/lpage/biz/200611/kt2006110617463411890. htm.

Body image by Hye Young Byun Essay

Some deny it, some may not show, but we all know that every woman is self-conscious about her body and want to fix it. How often do you look yourself in a mirror and imagine how good you would look if you lost ten pounds? It is either that your butt is too big or too small, or your waist is too thick, your legs look like tree trunks, or your nose is too high or flat, your eyes are too small or your skin is oily and the list seems endless. The heroin chic is on trend, where a person is too skinny she looks to be involved in heroin abuse. Recently, a 22 year old woman Luisa Ramos died of heart failure from Anorexia Nervosa. Actresses and models are becoming younger, thinner and taller. Media knows that we have low self-esteem so they attack us, women of all ages. Many women regardless of nationality or age contain negative body image and if they do not develop healthier body image, they will suffer physically and emotionally. How bad is our negative body image? During childhood, we grow up, looking at Barbie dolls, which is too skinny in size that if she were made into living person, her back would be too weak to support her upper body, and her body would be too narrow to contain only than half of a liver and only a few centimeters of bowel. When we grow older, we watch makeup and beauty product ads that contain models that are severely underweight. Studies have shown that 81% of women in Canada feel anxious and insecure after watching a 30 second advertisement promoting beauty improvement on TV. (Wellness edu) Firstly, our negative body image causes us to think that we are bigger in size than reality. A study found that women overestimate the size of their hips by 16% and their waists by 25% yet they were correctly able to estimate the size of a box. (Nancy Hayssen blog-Shocking body image statistics) We think that our body is fatter than it actually is, because we feel depressed when comparing our ‘normal’ body to ‘fake’ images in media. Secondly, containing unhealthy body image makes us have unnecessary fear of gaining weight. Recent study stated that young girls are more afraid of becoming fat than experiencing nuclear war, cancer or even losing their parents. (Wellness Edu) It is terrifying to see that media’s influence even applies to women in such young age. Lastly, having an unhealthy body image will cause women and even men to waste unbelievable amount of time fitting into the ‘ideal’ body. Two out of five women and one out of five men would trade up to five years of their lives to achieve their weight goals. (Wellnessbeing-edu) Also, the average woman in North America spend 2.5 years of her life washing, styling, cutting, coloring, cramping, and straitening her hair at home or in salon. (120 Wolf, 1991) We become prisoner of perfect body without even realizing it. Lots of us think it is not a big deal. But here’s the problem. Body image involves our perception, emotions, imagination and physical sensations. Having negative body image damages all of these parts. Having negative body image will bring many negative effects to women. Firstly, it will lead to depression or lower self-esteem. Feeling insecure and less confident, women are more likely to believe or fall in for the exaggerated advertisement shown in media. They will look at air brushed models or celebrities who has gone through several cosmetic surgeries, and feel ashamed of their own body. Women will experience financial damage from spending lots of money into cosmetics, clothes, diet products, and even cosmetic surgeries. The diet industry itself is worth between 40 to 100 billion dollars a year only selling temporary weight loss programs! (People magazine Sept.2000) Secondly, unhealthy body image will lead to Eating disorders or bad habits. One of four women in early 20s in North America uses unhealthy methods of weight control like fasting, skipping meals, excessive exercise, laxative abuse, and self- induced vomiting.(American research group Anorexia Nervosa& related Eating Disorders Inc.) The pressure to be thin is not only affecting older women but young girls as young down to 5 or 6. Nearly half of all girls wish to be thinner. (â€Å"Appearance Culture in Nine-to 12-Year-Old Girls: Media and Peer Influences on Body Dissatisfaction†) Last, but not least, women could develop disorders like Anorexia Nervosa. Anorexia is a disorder where a person has extreme fear of gaining weight, and women with this disorder believe themselves to be overweight when they are actually visibly underweight to the point where they need hospitalization. Up to 450,000 Canadian women were affected by Anorexia Nervosa or extreme eating disorder in 2006. (Teen Vogue 2006) Many women if not all, mostly think that worrying a little about their health is not a big deal or a good thing. But they don’t even realize how severe their worrying has become. It has become severe to the point where they lose their identity. If you as a woman do not stop having unhealthy body image, it will lead to very unhappy life. So how do we not have negative body image? It seems so hard to just let go and be free. Women’s biggest concern and biggest interest is beauty. There are lots of ways to keep you healthy, but free of pressure, and stay beautiful but still have positive body image. First, you need to accept people of all sizes and shapes. (Margo Maine’s book â€Å"Body Wars,†) You can even make a list of people that you admire regardless of their body. Does their outer appearance affect how you feel about them? Appreciating the people around you will help you appreciate yourself. Secondly, another way to avoiding having negative body image is to question Media’s messages. (What Do You See When You Look in the Mirror?, Thomas F. Cash, Ph.D., Bantam Books, New York, 1995.) Media is a powerful source that could influence women. 96% of normal women in Canada do not match up to the models and actresses shown in the media. Average model is 5’10† with weight of 110 pounds, while the average woman is 5’4†³ with weight of 142 pounds. Women should remember that most of the images presented have gone through Photoshop or have been airbrushed. They also need to learn that media is not hundred percent honest to reality. Lastly, women today need to learn to listen to their body, not abuse it. They should eat when they are hungry. Staying fit in the healthiest way is to eat when you feel hunger, and to exercise in an enjoyable way, regardless of stress, or pressure to lose weight. While listening to their body women should also ask themselves this question: Would I rather spend my precious time with my family, friends, on school, and on career? Or would I spend it on pursuing the â€Å"perfect body image†? I don’t think anyone would give up their quality time with family on for accomplishing lower weight goals. All of these things will bring great benefits to your life. Today, in Canada, we have freedom to accomplish whatever we want to. Yet, women are prisoners of beauty myth, and appearance. Negative body image is a serious problem and has damaging effects on women’s self-esteem and it can lead to depression, as well as an eating disorder or other disorders like Anorexia Nervosa. It also causes women to waste time on diets, or improving their outer beauty, and also fear gaining weight more than anything. Medias influence us every day, producing air brushed models that are severely underweight. Media causes women to feel angry and anxious about their own body. But we can develop healthier body image if we appreciate ourselves for who we are and listen to our body. We lose lots of women in Canada that starve themselves to death. Women need to learn to self-love and respect their body instead of abusing it. Our bodies are not our enemies, and it is our responsibilities to stay unique and set our own trend.

Definition And Definition Of Curriculum - 1698 Words

Definition of Curriculum Paper Bevis (1989) defines nursing as a process whose main purpose is to promote optimal heath through generative, nurtrative and protective activities. These activities are always carried out with three client systems namely; community, intrapersonal and interpersonal system. The term curriculum in nursing can be defined as planned learning experience that the educational institutions plan to present to its learners. Educational institutions are charged with the role of ensuring that it assists its learners to become critical and intelligent citizens in the society. From the historical perspective, curriculum originates from the Latin word currere meaning to run a course or to run. It originally meant to pass from one generation to the next. The popular understanding of curriculum is a program of studies with specific courses that lead to academic degree, diploma or certificate. According to Olivia (2009) curriculum is a program or plan for all experiences that a student encounters under the course of school. There are various components in the nursing curriculum. Some of the components include: †¢ Psychiatric Cerebral Health Nurse Practitioner †¢ Adult-Gerontology Primary Care Nurse Practitioner †¢ Community Health Nursing Family Nurse Practitioner †¢ Nurse-Midwifery †¢ Adult-Gerontology Acute Care Nurse Practitioner †¢ Perinatal Nurse Specialist †¢ Adult-Gerontology Clinical Nurse Specialist †¢ Pediatric Clinical Nurse Specialist †¢ PediatricShow MoreRelatedCurriculum Definition And Definition Of Curriculum2273 Words   |  10 PagesWhat is Curriculum? According to Stotsky (2012), curriculum is a plan of action that is aimed at achieving desired goals and objectives. It is a set of learning activities meant to make the learner attain goals as prescribed by the educational system. 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