Reflection on Poems The Things They Carried, Dulce et Decorum Est, Essay

Reflection on Poems The Things They Carried, Dulce et Decorum Est, Facing It, War is Kind and The rubor Convertible - Essay ExampleFor example, The Things They Carried by OBrien taught me to sympathize people, who had participated in Vietnam War. The author stresses that soldiers always carry with them the heaviest cargo thoughts and memories about cruel battles and pain. They carry this weight even when the war is over. As for Dulce et Decorum Est by Wilfred Owen, it also helps to look at wars closer than I used to. In this poem the author describes in all the horrors of war in much detail. He shows soldiers poor life and impossibility to have a rest. It is difficult to hold back a tear magic spell reading the lines about the soldier who cannot escape from a gas attack. In Facing It by Yusef Komunyaka the readers attention is focused on the alkali of war and death. The speaker faces the Vietnam War Memorial and understands that he is a part of that war because he participated in it. He remembers all the people, who died during the war and wishes it had never happened in his life. The Red Convertible makes the reader face an awful situation that happens to the poems speaker.

Strategic Analysis for Cathay Pacific Airways Dissertation

Strategic Analysis for chinaware Pacific Airways - Dissertation ExampleCathay Pacific, during the global financial crisis in late 2008 and 2009, has incurred a personality high of $ 7 billion loss (Cathay Pacific 2010). This is the offshoot time that the company has ever experienced such a huge loss. However, by 2010, the company has reached an all time high of $14 billion profit (Cathay Pacific 2010). Although this turnaround is attributed to the continued growth and strong performance of the Chinas economy, what Cathay Pacific shows is astonishing since the airline business, fundamentally, involves heavy investments, but relatively slow return on investments. Yet, Cathay Pacific has gained monumental profit during difficult sparing times. In this sense, by looking into Cathay Pacifics approach and strategy as the company surmounts the hurdle of the global financial crisis with excellent profit, single can learn from their experience as it provides a paradigm that can be used by most companies who are still reeling from the impact of the novel global financial crisis. In this regard, Cathay Pacific strategic management offers alternative frames that can be useful for companies as they address the challenges and impact of the first global economic crisis of the 21st century. 1.1. Background of the Study The airline industry is one of the most dynamic and robust business sectors in the world (Meersman, forefront de Voorde & Vanelslander 2008). Its business cycle is consists of ups and downs that continues to modify and restructure the demands and framework of the airline industry market (Uncles & Goh 2002). In this regard, it is significant to understand the important factors contributing to the robust record of the airline industry. In addition, by looking into the elements modifying the structure of the industry, the approaches develop by the companies not only becomes contextualise, but it also affords the chance to apprehend what is the basic though tfulness of the airline industry. One of the most important factors affecting not only the airline industry but all businesses and countries around the world is globalisation. Globalisation is the removal of trade barriers existing among nations. With this economic policy adopted by most countries around the world the movement of goods, capital, services, products, culture and people has become freer flowing, thus allowing for exchanges to take on (Coatsworth 2004 Fougner 2006 Munck 2008). In effect, eco0nomic policies of governments have shifted from

What is the best way to address obesity in the United States Essay

What is the best way to address obesity in the united States - Essay instanceIf we look at obesity etiologic whollyy, we would come to know that it is a multifactor issue caused by poor diet and physical inactivity. Poor diet refers to poor dietary habits overwhelm intake of junk food or high calorie fast food and excessive sugar in our diet. Instead of using newly food, fruits and vegetables in our everyday diet, we prefer preserved or frozen food followed by no exercise or physical activity at all. One of the to the highest degree common reasons for rapid increase in obesity among U.S population is the increased interaction of people between built in environment followed by engineering and affectionate context.The built in environment encompasses the entire range of structural and social elements that make up the fabric of a community housing, roads and walkways, stairways, density, dit networks, shops, markets, parks, public amenities, and public spaces. The structural feat ures of the urban built environment its enormous size, its large and densely clustered population, its social institutions, its psychosocial stressors, its economy, its rapid pace, its violence, the configuration of its streets, parks, schools, and play spaces all affect health, growth, and development of individuals. (Frieden et al, 2003, p. 684)The rising trend in obesity is further followed by the convenience, which is driven by modern technology like the concept of walk of life is becoming vague by the passage of time people like to use any mode of transportation in order to travel withal minute distances. In this kind of technologically savvy society, modes of entertainment have changed. Gone are those days when parties and social gatherings were considered to be entertaining. Today, entertainment comes through watching television, playing video games and sitting for hours in front of computer. Hence our lives are driven by a sedentary lifestyle escorted by technological adv ancements. art object coming back to foods it is found that often people in United States feel insecure when food is concerned. The diet of food insecure people tends to be less healthy. One reason for the intake of frozen foods is that canned fruits and vegetables, which tend to have more salt and sugar, are much less expensive than fresh fruits. Leaner cuts of meat tend to cost more. However, according to Dr. Walter C. Willet, A calorie is a calorie is a calorie. (Willet, 2001, p.44) Theoretically, no matter how unhealthy a persons diet, that person can only gain weight from fat by using fewer calories than he or she takes in. The quality of diet would only affect competency to disease and health problems. (Obesity1)In my opinion there are two reasons for very little choices in food, one leads to the economic infrastructure of United States in which healthy and nutritious foods are often more expensive than junk or fast foods, also they are easily available and accessible by all the classes. The second reason for no choice in food other than fast food is the lack of time. More than half of the population of United States believes in time is money, whether it is middle-middle or middle-upper class, every individual has to work in order to achieve a better living. It seems there is a social race in which every individual wants his car to move faster and faster, due to which they have no time to prepare and enjoy their family life and so

Effective pain relief in postoperative patients Essay Example for Free

Effective hassle re duplicityf in postoperative patients Essay annoying is physiological mechanism and a means of the dust alert the person about either currently present or impending damage to it. It crowd out be defined as the unpleasant sensory and emotional experience associated with actual or potential damage (Gelinas, 2004). Consequently, the words discomfort has also been used interchangeably with wound in the past and screwing be defined as a negative affective and/or physical state subject to variation in magnitude in solution to internal or environmental conditions (Gelinas, 2004). Pain is a very important component in care of the surgical patients, both preoperative and post operative. surgical procedure itself afflicts large amounts of trauma on the patient. The irritation that the patient has to incur afterwards adds his anxiety levels and stresses the body. Lack of or inadequate amounts of anguishfulness lie withment by the staff, impacts the patients b etter process. Their mobility and in the long terms their duration of hospital stay is also affected. It is important that, for optimal patients health management and care, a means tool must(prenominal) be available to measure the patients pain respectment and relief assumement through pharmacological and non pharmacological means.Little research has been done to properly assess and document the prevalence of pain and its management protocols in post operative patients. The pain scoring systems are available to attempt to quantify pain and manage it accordingly. These unobjective ones include the categorical rating scales (CRS) in which patient rates pain from No to mild moderate or severe. Another one is the optic Analog score (VAS) where the individual scores are placed on a 10-cm line where the left anchor point is labeled no Pain and the right anchor point is labeled worst possible pain.Since every patient has a varying threshold for pain, and requires varying levels of dru gs, to over come along the pain, it is better for there to be both a subjective indicator for pain as vigorous as an objective one, that is to say, that the nurses an also assess how oft pain the patient is in, by using a tool she is provided with. Cardiac surgery is a major thoracic surgery and patients post operatively require lot analgesics to manage pain so that their morbidities associated with pain (like pain in breathing, walking etc) can be eliminated.Usually morphine is used for the purpose of pain relief but there are indications that Fentanyl can perform a similar relief without much of the side effects associated. There needs to be some focus into this theory. This can be achieved by placing 2 similar populations of adult cardiac patients who have just undergone cardiothoracic surgery on morphine or Fentanyl. As is the standard procedure nowadays, fibre indicators, both subjective and objective can be used.The VAS pain scoring card can be provided to the patients for them to record the different levels of pain that they feel. The nurses would be provided with indictors to record objective findings which can indicate pain. These can be physiological and behavioral indicators. The physiological indicators can be clustered into cardiovascular, respiratory and cerebral responses (Gelinas, 2004). Pain associated responses would include tachypnea in respiratory, tachycardia and increased blood pressure in cardiac and raised ICP in cerebral responses. aft(prenominal) assessment of the pain levels with the quality indicators, the pain management drugs exit be administered and later the subjective and objective pain assessment will be repeated to see which drugs effects were greater and lasted longer. A lead conducted by Celine Gelinas on critically ill incubated patients, to find out what are the protocols and tools used to assess pain management are and if the patients were be given effective relief. He used subjective as well as objective tools. T he results revealed that physicians placed no intent in documenting pain in patients.Most of the reporting was done by nurses and the patients. It was also noticed that nurses assessment of pain was much little than that reported by the patients themselves. The research concluded that the documentation overall about the pain and its management was incomplete in general with little attention being given. The research also noted that even after being notified about the pain, its effective management only took place 60 percent of the time. (Gelinas, 2004). In and interventional study conducted by Francoise Bardiau in 2003, the quality indicators e. g. VAS were introduced in the surgical and anesthesia department.After a survey of assessment of knowledge of nurses, VAS to assess pain was the nurses worked to improve pain management. After further surveys, it was noted that initiation of programs to setting of quality indicators improves the overall pain management system. (Bardiau, F. , M, 2003) Idvall E tested a 5 point scale to measure the effects of quality indicator maintain pain relief measurements.The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated. Idvall E 2002) a multidisciplinary program development was introduced based on evidence based medicine to focus on construction of proper management protocols to implement clinician as well as patient based pain relief programs The results suggest that addressing pain management through a variety of strategies targeted at the level of the institution, the clinician, and the patient whitethorn lead to desired changes in practice and better outcomes for patients. . Bedard, D (2006).A survey conducted on post operative cardiac intensive care unit patients, about their pain experiences revealed that despite the pain management regimes in place nowadays, the pain fre quencies, and intensities were the same as they were more than a decade ago. Pain management is a zippy component of patient care. Quality of pain management can only be assessed through proper indicators. These can be multimodal. The patient populations on which these indicators can be applied are preoperative and postoperative patients.Post operative cardiac patients under nursing care can benefit well from carrying out of quality indicators such as VAS. In the nursing profession subjective scoring by the patients themselves enables the nurses to manage the pain properly. This will lead to quicker retrieval by the patients and earlier discharge. In the long term this means leads financial implications on the patients due to reduced hospital stay. Also nursing work make full gets reduced as the patient tern over is increased. The healthcare cost gets reduced. A Post operative pain management (POP) project was conducted in 2003.A comprehensive survey was done to see the implemen tation of quality improvement projects in the field of pain management, it was noted that more than 70% of the hospitals were reportedly satisfied with the implementations and the outcomes of the quality improvement programs. Based on the analysis, it is noted that on the positive side, proper implementations of the quality indicators and improvement programs in the healthcare system and especially in the ICU and surgical wards, the patients stay can become quite comfortable.The stay can be reduced and the cost of healthcare to the system, the insurance companies, and the patient themselves can be reduced. In the other hand we can clearly see that by using the indicators we in effect are placing more workload on the nurses. If the subjective VAS and the objective physiological changes in the patient has to be monitored regularly just to assess the pain levels, a lot of quality time will be wasted.This time could have been used to tend to more critical patients. Now the question aris es if it is worth the effect to implement the QI programs. The answer would lie in Force field analysis and the Lewins theory. If the benefits out way the set backs, we can implement the system. The idealistic thing would be that we assess the pain management needs of each department of the health care system and implement the QIs in the ones in which the implementation benefits out way the costs.

United States Declaration of Independence Essay Example for Free

United States answer of liberty EssayDeclaring Our libertyThe firmness of Independence was approved by Congress on July 4th, 1776. It was compose by Thomas Jefferson and published by John Dunlap. After it was written it was sent to oecumenic George Washington to be read to his troops in New York who were getting ready to fight off the British army (Library of Congress).The Declaration of Independence has been fountainhead-nigh for almost two hundred and fifty years, many things micturate modifyd in this coun afflict in that amount of time. Does the Declaration still hold the same determine as it did back then, or has it evolved everywhere time to have a different meaning? What was the purpose of the Declaration of Independence and why is it still looked upon so highly today? Was there more(prenominal) to the Declaration of Independence then average getting free from Britain or did it also lead the room to reach America? All of these questions will be answered in th e following paragraphs to have a better understanding of re ally how grave one piece of writing can be to a dry land.A good way to start to understand what the Declaration means is by looking at the first hardly a(prenominal) lines. When in the Course of human events it becomes necessary for one concourse to dissolve them with a nonher to assume among the powers of the earth, the separate and equal station to which the Laws of nature and of Natures God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to separation (US 1776). This part of the Declaration of Independence is talking about how Britain became such a pain to the colonies with all of their taxes and their rules that the decision it was in their best interest to leave from the rule of Britain and form a new nation. Not only was this addressing those who called themselves Americans just now all of mankind. They did this so that they could have more volume able to assist them in the fighting of Britain (Library of Congress).Britain was deeply in debt. Mercantilism was orthodoxy, and as such, the thought was that the colonies should sum up more to the common security of the realm (Halvorson). Another thing that Britain did to make the colonial settlers upset was that British soldiers were allowed to stay in any of the houses in the 13 colonies with little or no reason to why. It made Britain look very evil in the eyes of these settlers and the first paragraph of the Declaration reinforces this idea.The second paragraph of the Declaration of Independence might possibly have the single most important idiomatic expression in all of the united states. The first sentence contains the phrase all men are created equal. Now in 1776 this phrase was probably taken more literally meaning that all men would have rights and Jefferson treasured to exclude men and women. However, some argue that all men are talking about all of humanity. Numerous times thought out report important figures such Abraham Lincoln, Martin Luther King and Elizabeth Cady Stanton have referenced the Declaration of Independence when try to obtain equality for Women and African Americans. In 1857 Lincoln had mentioned that the assertion all men are created equal was of no practical use for separate from Great Britain and was placed in the Declaration for future use (Armit era 44). As thoroughly in the 19th century, the Declaration of sentiments played a key role in the women rights movement and almost mirrored the Declaration of Independence (Halvorson). Without those five small, simply powerful words the United States would be a much different place then it is today. The meaning of the phrase has changed over time allowing even more than just men being equal. Today the United States of America tries to make everyone equal even if at times it might now seem that way. It didnt have anything to do with trying to leave Britain, Jefferson put that phrase in there for the future of this country.The Declaration of Independence gave some insight on the topic of Popular Sovereignty. Popular sovereignty is the doctrine that sovereign power is vested in the people and that those chosen to govern, as trustees of such power, must exercise it in conformism with the general will. Basically, it means that the people can come up with the government and make it, however, the people want it to be. The Declaration gives the power to the people and not to the governing body that is governing them. Governments are instituted among Men deriving their powers from the consent of the governed(US 1776) Without this we might have formed a new government in the United States but it could have very well ended up as a monarchy. Popular sovereignty is key to making a peoples government and the Deceleration of Independence distinctly reinforces this.The Deceleration of Independence also informs the public of the Social Contract. The Social Cont ract is the agreement among individuals by which ordination becomes organized and invested with the right to secure mutual fortress and welfare. Both the government and the citizens are part of this social contract. The people be a part of the decisions and if they disagree with the government then they can just change it. That whenever any Form of Government becomes destructive of these ends it is the Right of the people to alter or to abolish it and to institute new Government(US 1776). It seems in this day and age that people are afraid to stand up to the government and fight for what they believe in. Currently, many congressmen and congresswomen are being bought out to vote in legitimate ways over the topic of Net neutrality. It would be the peoples job to step up and talk with their representatives and show them what they are interested in and not permit corporation buy out their representatives. The term natural and Induvial Rights also comes up in the Declaration of Inde pendence. These are rights that all people should have. These rights include life liberty and the pursuit of happiness. They share the values of granting immunity equality and justice. No one should be able to take these rights from people, and it is up to the government to make sure that the peoples rights are protected. Without the government to protect the rights of the people things would start to fall apart for society. endowed by their creator with certain unalienable Rights that among these are intent Liberty and the pursuit of Happiness(US 1776). These are what are also known as the Universal truths and over the course of the next two decades, America would try to benefactor other countries around the worlds come to have similar Universal truths as to what is stated in the Declaration of Independence.Not only was the Declaration important in assisting the start of this nation and help to fight for freedom of Brittans monarchy, it is also utilize today to influences mode rn American political culture. One way it has influenced political culture is it has caused us many reasons why America chooses to go to war with countries who might seem like the people are being loaded in some way by the government. America looks on to the Declaration as a sort of moral compass when it comes to deciding whether or not it is right to go into other countries and try to abolish any oppression that is going on. As a continuing inspiration in the United States and throughout the world to end oppression and to make sure that all groups of people enjoy a self-government and representation of both their collective interests and their personal freedom (Pencak 234).Today more than ever you will see this power abused by people in America to try to gain more than just helping an oppressed people. If you look at wars today that the United States are involved in some of them are masked by the idea that these groups of people are not free and do not have access to the natural r ights that the Declaration of Independence refers too. Instead, you have people who are fighting over others natural resources and land first and the rights of the people come second or dont even come at all. The same ideologies that this country was reinforced on are now being using selfishly into a power grab for land and money from other countries.The Declarations aspirational ken has had a remarkable influence on American notions of liberal equality, even in the days when only white males could formally participate in political sympathies (Tsesis 698). It has also been referenced a lot in current social movements today. Groups such as Black Lives Matter and Arab spring and Tiananmen Square openly and repeatedly invoke in the Language and the ideals of the document (Halvorson). This shows how the Declaration can be used as a voice for the minority groups in America to help end the oppression that they might be facing.In conclusion, the Declaration of Independence is a lot more than some old piece of paper written by a bunch of old white guys. It is more than that, it is many things. It was a letter to the British telling them that they dont wish to be a part of their empire anymore. It was a way to bring hope to the oppressed and way to make sure that one day everyone in the nation and even on the earth was treated equally. Over time it has been used for good by the majority of people and some have even used it to justify bad doings. Overall the Declaration was important in the forming of America and is important for what the country should form into of the course of time. It was tough for the founding fathers to frame what society would look like in the next couple of decades but they did a great job in laying the bricks for the path they wanted the country to become. Without the Declaration of Independence America could still be under the rule of the British. Women would not have as many rights as they do now, slavery could very well be a thing in this country without this document. The world would be a much different place then what it is today. It is nowhere near staring(a) but it is the Declaration of Independence that pushed everyone in the world a little bit closer in the right direction towards freedom.Work CitedArmitage, David. The Declaration of Independence and International Law. Foundations of Modern International Thought, Jan. 2002, pp. 191214., doi10.1017/cbo9781139032940.017.Halvorson, Seth D. Historical Context for the Declaration of Independence. Columbia College, www.college.columbia.edu/core/content/american-revolution-and-founding-texts/context.Pencak, William. The Declaration of Independence Changing Interpretations and a New Hypothesis. Pennsylvania History A Journal of Mid-Atlantic Studies, vol. 57, no. 3, 1 July 1990, pp. 225235. JSTOR, www.jstor.org/stable/10.2307/27773386?ref=search-gatewaydb0ae02fe1b84f163f034404f6687764.Creating the United States Creating the Declaration of Independence. All Men argon Cr eated Equal Creating the Declaration of Independence Creating the United States Exhibitions Library of Congress, www.loc.gov/exhibits/creating-the-united-states/interactives/declaration-of-independence/equal/index.htmlCreating the United States Creating the Declaration of Independence. Index of Documents for All Men Are Created Equal Creating the Declaration of Independence Creating the United States Exhibitions Library of Congress, www.loc.gov/exhibits/creating-the-united-states/interactives/declaration-of-independence/equal/documents.html.The Declaration of Independence Full Text. Ushistory.org, Independence Hall Association, www.ushistory.org/declaration/document/.Tsesis, Alexander. Self-Government and the Declaration of Independence, 97 Cornell L. Rev. 693 (2012) http//scholarship.law.cornell.edu/clr/vol97/iss4/1

Saving Private Ryan Essay Example for Free

Saving Private Ryan EssayThe ingenious film, directed by Steven Spielberg, Saving Private Ryan is in my horizon the most realistic film to ever portray the D- Day landings. Many critics befool even said it to be so vivid that the only piece missing is the smell. In the Films first battle scene, finallying twenty- five minutes in total, it brings all reality into the living nightmare that took place so colossal ago. Brought back into life by Spielberg, I pull up stakes put tidy sum how he creates excite ment and tension in the most realistic of ways. I will prove how he portrays the lineaments, his use of reasoning(a) and last of all, his use of camera peters and how they contribute to the overall effect of the scene. Spielberg manifests an overall memorable opening scene and I will show just how. Released on the 24th July 1998, Saving Private Ryan promised to break all blockbuster records and go straight to the top. Spielberg stunned the world with the films world an d authenticity, proving that his renowned reputation is non just hearsay, but fact.The plot is loosely inspired by the true story of the Niland brothers, where dickens of the four were killed and the third, presumed loose. The decision was make to retrieve the fourth, to prevent a national uproar and from a whole family from macrocosm wiped out due to War. The plot, proving exciting, brings much controversy over the mission to peril eight lives for the sake of one. The whole epic World War 11 drama cost approximately $65 million in total, most of which was worn out(p) on the graphic detail and effects in the first battle scene of the film. Although the twenty-five minute battle scene is complex cinematically and visually, the plot of the marge landings follows through reasonably simply. The scene starts off in focus of a small regiment of troops, quivering inside the hull of a boat, petrified by the sound of oncoming machine gun fire.The ramps fall down as a wheel spins round , pronouncing the ends to most of their lives. The boat opens out as many are shot dead instantly by the flurry of bullets thrust toward them. Few make it out a live before they have to plough through thousands of dead up the beach. As the battle scene cuts into view, the first character to be seen visually is police captain Miller. This immediately indicates that he is high up in caste and so, instantly gives him a commanding presence among the craft.The calmness of his voice even seems to sedate the tension in the atmosphere. However, the initial part of him to be seen is his pair of horror hands. This conventionally is a sign of fear and to some, may show a weakness. Leaders are not usually associated with fear stereotypically they are fearless. Spielberg has used this ironically, to show the realism within his character. All the soldiers fighting on that day were normal citizens fighting for pride and country. They all experienced fear. On D- day there were no fearless war he roes such as John Wayne and this is why Captain Miller, along with all the other troops, is shown in affright. As the shot moves outward, the whole of Captain Millers body is revealed.His fashion can be seen and again realism is reinforced. The person acting as Captain Miller, Tom Hanks does not have the stereotypical appearance of a War hero he is small, placid and in lack of the muscle attributes usually associated with a clichi d soldier. done this casting Spielberg conveys a message. The men fighting on that day were normal. They werent all large men built of muscle, who could defy death and so, the person cast as Captain Miller isnt either. through this, the character of Captain Miller is made realer to the auditory modality, thus do the film more accurate and historically correct.On the beach, after the regiment has landed, the Captain experiences a brief period where his emotions and conscience are thrown into turmoil. The horror of what is happening around him starts t o sink in, as all terror results in a amiable breakdown. The fact that he does not just march through the beach and that he is affected shows his compassion and empathy. It shows he is a caring human existence one who is gravely affected by the horrific things being done to his comrades.Through this period of collapse, Spielberg creates lots of tension, as the audience, who have gradually started to become link up to this realistic character, are willing him to snap out of it and gain his composure. They want him to get out of this situation and lead his troops up the beach. Another character that stands prominent in this scene is that of serjeant Horvath. Spielberg has used Horvaths character to contrast with Captain Miller, and this is seen even in the first few seconds of his di but. Immediately as the audience set eyes upon his broad build, it can be seen that he is much more robust than the Captain and that he conforms more to the stereotypical image of a fictional war her o.I think that Spielberg has highlighted this point emphasise the normality and ordinary image of Captain Miller. He has done this to show that soldiers were all shapes and sizes. Through this contrast made, the realism of both characters is increased as they both can be recognised uniquely. Horvath and Miller again contrast in their methods of dealing with the trepidation and horror thrown at them. Whereas the Captain releases his petrified state through the constant trembling of his hands, Horvath allows his fear to disperse through chewing. Through Horvaths different reaction, Spielberg defines his character more, making him more realistic as he deals with situations in a different way.As soldiers in real life all reacted uniquely depending on their personalities, Horvath does too. The audience then can identify better with him, likening him to people they know, thus recognising him as a real type of person, one who is unique. Although Captain Miller and Sergeant Horvath contrast in many ways, together they form a prevailing partnership. In every order relayed by the Captain, the Sergeant reinforces it, thus portraying his regard, proving that he has an immense admiration for the man. Horvath continuously stays close to the Captain, waiting for his command and looking out for him.Spielberg uses him as the Captains right arm. Everything about Horvath, from his bear like face, down to his cumbersome build, shout valueor In view of this, the audience take a liking to him and confide comfort in the fact that Horvath will protect and bring their everyman (the Captain) to safety. Spielberg uses the relationship between the two characters to excite the audience, as he shows that War is so out of the ordinary, that it brought together people in friendships who otherwise wouldnt have done so.Captain Miller and Sergeant Horvath have such a strong relationship during this scene that excitement arouses among the audience, as they know that together the two will surviv e. Private Jackson, the regiments sniper is another character that has an essential role in the battle scene. His preliminary appearance is in the landing craft, immediately before the ramps descend. His face, being one of pure dread is an open book to the audience. He is so terrified that his face and the first act that he commits, a kiss on a cross, show that he believes that there is no hope for survival left. It is as though he thinks that a kiss on the cross is the last action he is going to do and that if God is ever going to come to his aid, let it be now.I think that Spielberg has used this crucifix and his expression of misgiving, to draw compassion for the Private, but also to show how close death is to God. Immense suspense is created through the terror in Jacksons eyes. Private Jackson is not focused upon much during the struggle to gain ground and progress up the beach, however is substantial in the climax of the Scene. In this section of the scene, there is a long pau se where the camera focuses upon the concentration on Jacksons face. He is speaking to God as he prepares to shoot and kill the Germans.

Complications of Post Angioplasty Bleeding

Complications of Post Angioplasty BleedingIntroductionThis paper is aiming to identified the potency complication of dapple angioplasty exhaust and abrupt closure of coronary artery base on the case of Elizabeth Green from caseworld and explore the issue in astuteness and widen horizon. Relevant care for decisions and recommendations of stigmatise angioplasty care will be provided and discussed which is based on clinical guideline of the University of Minnesota Hospital and Clinic(UMHC).This article is coordinate into three aspects which are indications of the percutaneous coronary angioplasty and Mrs Greens data, evidence-supported nursing interventions for exhaust baffleion and evaluation of the interventions regarding to ANMC competency elements. The de circumstanceine progress of individual political program and lineament improvement of unique care will be presented.Indication of the percutaneous coronary angioplasty and Mrs Greens case dataApart from a very small pe rcentage of individuals who has difficulties to pass the guide wire or the balloon catheter through the narrow artery, 90%-95% of unhurrieds sess be effectively palliate from coronary arterial obstruction after the percutaneous coronary angioplasty.Percutaneous coronary angioplasty is a non surgical treatment offered to persevering with coronary artery disease, the major(ip) aim of this social function is to increase the arterial lumen size and allow greater blood flow. A ballon tipped catheter is utilise to split and reshape the atheromatic material, pushing it to the artery wall therefore more blood tail end be transferred through the particular artery.Abrupt closure of the dilated coronary artery and bleeding are two uncommon but possible complications for Elizabeth Green within the very first few hours post angioplasty.The cause of abrupt closure varies, it can be due to combination of dissection of the inner lining of artery , thrombosis and spasm at the balloon site. A s to assist in preventing thrombosis formulation during or post percutaneous coronary intervention, oral anticoagulant medication including aspirin will be administered to avoid platelets from adhering the artery wall and stimulating blood clotting. To further prevent blood clotting, intravenous heparin or synthetic analogues of heparin molecule can be given to the patients.The anticoagulant medicates can help reduce the happen of abrupt closure however can institute to increasing risk of post angioplasty bleeding. Giving the fact that Mrs Greens gender, age, past history of tottering angina and episode of heart attacks make her at high risk for bleeding or bruise on the puncture site.The femoral cause is funnel-shaped and consist of femoral artery, femoral vein and lymphatic, If there is a bleeding in the femoral sheath, it can spread to the ab wall follow the wall of the sheath. in that location will form a continuation of the transversalis fascia and the femoral sheath ca n directly connect to the anterior group AB wall.Differ from bleeding to abdominal wall there is a nonher kind of post angioplasty bleeding named rectus sheath hematoma (RSH). The damage or tear to the superior or inferior epigastric arteries can result in bleeding into the rectus sheath. In many case of major bleeding,RSH can also lead to other complication including multiorgan dysfunction and abdominal compartment syndrome Even the fact that RSH has not been ferret outed post a PTA procedure, when patient present episode of acute abdominal pain, RSH can be considered as a differential diagnosis.evidence-supported nursing interventions for bleeding preventionFollowing AngioplastyAfter the procedure, pressure is required to apply on the site for about 5-10mintues in order to button up off the insertion holes in the arteries. Patient will be positioned to lie on their back with gauze dressing taped to the site for 4-6 hours. 4-6 hour is prim for normal blood clotting seals the ho le in the artery. On the other hand, patient fill to be priseed for recurring chest pain which indicate the procedure artery is re-closed, bleeding at the mole site and symptoms of dye-induced kidney damage.Guideline for the nursing care of a patient after percutaneous coronary angioplastyThe word guideline is chosen rather than standard is because clarify of term help in avoiding potential legal consequence. Literature has shown that, in a malpractice suit, standards may be used by plaintiff against hospital. Standards could be misconstrued for inappropriate purpose. In real case, if a patient is required a nurse to monitor observation every 15minutes in the first hour post angioplasty, legally the nursing staff can be charged for not implement the standard, even the nurse is considering patients urgent priorities. The term guidelines means those strategies are for quality improving and goals promoting for patient care. Nurse can roost independent nursing decision depend on pat ients individual circumstance.Nursing intervention for caring post angioplasty patient1.Vital signs should be monitored and documented every 15 minutes in the first hour post procedure then every 30 minutes for 2 hours, every hour for 4 hours then 4 hourly observation.Do not use reflex(a) blood pressure cuff.2. While doing each of vital signs, assess patient femoral site, symptoms of oozing , swelling and increasing pain show signs of hematoma. Especially when patient is coughing, sneezing, vomiting and flexing position on bed etc, there is a high risk of bleeding.3. If necessary or ordered, exam and monitor patients coagulation test result and hemoglobin studies, unremarkably it is done every 4-6 hours.4 Follow prescribed regimen to perform anticoagulation therapy (goal is to have partial thromboplastin meter 50-100)5 Put a blanket over patients extremity and tuck the end chthonian mattress so patients seawall site can be immobilize however pressure area like ankle and heel sh ould be protected by putting towels under6 Movement of the patient need to be minimized. Only move the patient bed to bed once. quash weighting patient unless ordered by fellow. When patient need to toilet, use bedpan and turn patient away from the procedure site same with lying on the bed always preferred on the side away from procedure site. If the patient need to change position, educate patient to ask for assistance7 Procedure site need to remain straight at the hips through out the process Educate patient not to extend and bend their limb.8 Educate patient to cover their groin site when they coughs and sneezes.9 Check patient medication history if he is on anticoagulant and provide assessment to the fellow for considerations.10 Do not perform unnecessary venipunctures or intravenous insertions ,intramuscular and subcutaneous injection only if the coagulation value is normal. Instruct the patient on all the above precautions and cares11 When patient present bleeding, hold press ure on arterial venous puncture site as longer as the bleeding seems to stop usually take 20 minutes or more. Avoid using sandbag or pressure dressing unless ordered by physician.12 Report and come through intern for any presenting bleeding or potential bleeding. . The PTCA fellow should be notified by the intern13 Maintain transparent dressing to site at all times.In patients discharge planning, health provider need to provide education pack of self-care of angioplasty and long-term care for coronary disease, these contribute in of complication of angioplasty and further cardiac issue. For example in this education pack instruction need to be provided including when they can recovery to normal activity, in the few day post angioplasty, heavy lifting and strong exercise should be avoided hence the femoral site can heal properly and if patient detect early symptoms who should they contact and what do they need to report to the G.PFor patients who have been prescribed with aspirin or other antiplatelet medication post angioplasty, they need to be inform what are the medication the patient must take and the purpose.Usually when stent has been implanted, patient will be administered clopedigrol(Plavix) once a day for within 2-4 weeks time. This medication is an potent aspirin-like drug which help reduce the clot formulation around the stent during the first week after the procedure. To avoid life-threatening complication, clopedigrol is a good prevention and patient should submit this medication before they discharged as prescribed.Specially for those patient who had medication history of anticoagulant to treat chest pain caused by the blockage, they can be resistant to the effects of aspirin thus regular blood examination is required to monitor patients response to anticoagulant and the doctor can adjust the dosage of aspirin or change the medication.Family support for the patient is essential in the recovery process, specially for elderly client who live alon e, family bid help in early detection of complication and maintain of patients regular social function.EVALUATION OF QUALITY CAREFirstly if the nursing goal is achieved, clinical outcome directly match to effort, according to ANMC competence it is the nurses responsibility to fulfill duty of care and prevent harm to the patient for example, rapidly identify bleeding in the post angioplasty patient.Secondly, practises in accordance with profession framework, understand clinical guideline and perform excellence quality of nursing care, for example, Avoid venipunctures on the post angioplasty patient.Thirdly, demonstrate analytical skills in accessing and and collecting patients data. In the case of the post angioplasty patient, this can be like assess patient on their procedure site and vital signs to and make independent nursing judgment to meet quality care.Based on the ANMC competency, nurse need to be able to identify individual and other team members responsibilities. Example i s the when there occur bleeding, the nurse should contact the intern for bleeding and report relevant assessment and information.Whats more, nurse need to use evidence-based practice and give patient step by step instructions for playing a task, for example with the onset of bleeding from groin site post angioplasty, nurse need to put on gloves and hold pressure on the sheath site for approximately 20 minutes or more.Last but not least set up individual care plan for patient base on their preference and clinical objectives to meet unique demand of the patient.ConclusionPost angioplasty bleeding can be life threatening complication hence it is important for the health provider to monitor and assess early symptoms for internal or external bleeding. To practice within clinical guide gain ground in prevention of the complication however individual situation should be considered and nurse need to make independent decision. Clinical guideline is aiming to improvement of quality of care thus evaluation of clinical outcome and feedback from patient play a role in improving practice.