The Taming Of The ShrewAnalysis Of The free essay sample

The Taming Of The Shrew: Analysis Of The Relationship Between Katherina A ; Petruchio Essay, Research Paper The Taming of the Shrew is known as the narrative that a hubby trains his nagging married woman. Shakespeare illustrates what a hubby and married woman should be ; he describes that a hubby should rule over his married woman and a married woman should obey to her hubby. It seems like that this is the narrative about sexism. In the book called # 8220 ; Broken Nuptials in Shakespeare? s Plays # 8221 ; by Carol Thomas Neely, Shakespeare? s # 8220 ; created male and female characters articulate tensenesss in dealingss between work forces and adult females as clearly, and sometimes possibly more clearly, than does the historical record, with its relentless inclination to wipe out female voices # 8221 ; 1 she says. Furthermore # 8220 ; this drama satirises non adult female herself in the individual of the termagant, but the male impulse to command adult female # 8221 ; 2 Coppelia Kahn says in his book # 8221 ; Men? s Estate # 8221 ; . We will write a custom essay sample on The Taming Of The ShrewAnalysis Of The or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page On the other manus, Hugh M. Richmond argues that the drama is covering with the? subject of the breakability of human individuality? 3 in his book called # 8220 ; Shakespeare? s Sexual Comedy: A Mirror for Lovers # 8221 ; . The drama begins with two sisters? matrimony proposals: Katherina is known as a termagant and Bianca is merely the antonym of Katherina, and the termagant must be married first. After this scene the drama systematically describes the procedure of Petruchio? s courting to Katherina. Almost the whole drama is about Petruchio? s taming of Katherina. Petruchio tries to develop the nagging married woman in every imaginable manner. For illustration he takes nutrient, slumber, and frock from Katherina as if he cares about her so much, and he denies everything she says? ? he neer allows her to be opposed. Katherina changes her behavior toward Petruchio as she is trained. Here, one inquiry comes up. A termagant means an unwieldy, a wayward, or an boisterous miss. Katherina is managed by Petruchio rather neatly. She listens and does what she is told to make. I would wish to analyze if Katherina is truly a termagant, and how she changes by Petruchio? s preparation through the drama. At the beginning of the drama, everyone calls Katherina? termagant? and everyone treats her as a termagant. However, she is a reasonably civil-spoken individual ; she merely quiddities. She looks like a termagant, but she is made up as a termagant. Harmonizing to Carol Rutter, and writer of the book called # 8221 ; blatant Voices # 8221 ; , people start populating the name if they are called reasonably, ugly, or whatever.4 Katherina is a good illustration of this instance. She is told she is a termagant, so she is moving as a termagant. When she meets Petruchio first clip, she agrees to get married him easy even though she splits hairs about what he says. If she is truly a termagant, she will non accept the matrimony. Her personality is strongly influenced by the fortunes that she has been populating in. Later in the drama she explains how she was raised: Your betters have endured me say my head, And if you can non, best you halt your ears. My lingua will state the choler of my bosom, Or else my bosom hiding it will interrupt, And instead than it shall, I will be free Even to the utmost, as I please, in words. ( IV.iii. 75-80 ) She has been populating with stating what she wants to state. Kahn argues, # 8220 ; her address is defensive instead than violative in beginning, and psychologically necessary for her endurance # 8221 ; .5 Expressing her thought frankly is her manner of life. She was non a born termagant. In Act 2 scene 1, Petruchio and Katherina meet for the first clip, and Petruchio # 8217 ; s taming of Katherina Begins. Petruchio # 8217 ; s method of chastening Katherina is barbarous: he comes tardily to the nuptials, drags her away from her ain wedding-feast, forces awful journey to his ain house on her, and nutrient and slumber are denied. Furthermore, he does non let her to dress in the manner. Petruchio acts as if he looks out for Katherina # 8217 ; s involvement all the clip. This is his scheme # 8216 ; to kill a married woman with kindness # 8217 ; ( IV.i.196 ) . G.R. Hibbard points out that Petruchio is coercing Katherina? to see the value of that order and decency for which she antecedently had no usage? .6 He trains her relentlessly. He does non care about her position at all. He describes his method: My falcon now is crisp and go throughing empty, And till she crouch she must non be full-gorged, For so she neer looks upon her enticement. Another manner I have to adult male my Haggard, To do her semen and cognize her keeper # 8217 ; s call: That bate and round and will non be obedient. ( IV.i. 178-184 ) # 8220 ; Katherina is trained, rather literally, as one would develop a hawk # 8221 ; 7 Alexander Leggatt says in # 8220 ; Shakespeare # 8217 ; s Comedy of Love # 8221 ; . Petruchio # 8217 ; s chastening method is barbarous, but it is non physical ferociousness, but mental ferociousness. He neer lift his manus against Katherina. Later there is a scene where Petruchio beats retainers up in forepart of Katherina. He is seeking to demo something to Katherina by making so ; he thinks that if he shows her that he is utilizing force on other people, she will detect that she had better be obedient to him. Petruchio looks terribly violent, but this is his scheme. In the following scene, Katherina, whom nutrient and slumber has been taken off, gets exhausted and starts doubting Petruchio? s contradictory behaviour toward her: And that which spites me more than all these wants, He does it under name of perfect love, As who should state, if I should kip or eat, ? Twere lifelessly sickness or else present decease. ( IV.iii. 11-14 ) In this scene she is stating, # 8220 ; I have no thought what? s go oning to me. Why is he handling me like this? I have neer face famishment, but now I am hungering to decease. Is it his intent to kill me by hungriness? # 8221 ; . While she is contending with the hungriness, she hardly keeps herself being sane, and she is puzzled by Petruchio? s behaviour. From when she senses that there is the concealed significance of Petruchio? s unusual behaviour, she might get down altering her behaviour. There are three scenes where Petruchio and Katherina kiss in the drama, and each one indicates the procedure of Katherina # 8217 ; s alteration. The first buss: right after repairing the day of the month of the nuptials, Petruchio desires a buss to Katherina. She does non talk because he kisses her about forcibly. It is obvious that she does non desire to snog him at all. Her silence displays her rejection of the buss. Here she neer tries to hold with him ; she is really stubborn. The 2nd buss, which comes at the terminal of Act 5 scene 1, is different. This clip Katherina gives Petruchio a buss in the center of the street. Actually he asks her a buss foremost, so she refuses, and allows. She kisses him of her ain agreement. Here she hesitates whether she should snog him or non ; nevertheless, she eventually kisses H im. She is altering her behavior small by small. She starts demoing the fruits of Petruchio’s learning. It is a test to prove the success of his preparation. The 3rd buss, which comes at the terminal of the drama, indicates the completeness of Petruchio’s taming of Katherina. When Petruchio kisses Katherina, she does non talk once more. However, her silence here is wholly different from the silence at the first buss. She even looks that she kisses him with pleasance. It is an look of her honest obeisance to her hubby. We can see the procedure of chastening Katherina in other scenes, excessively. In Act 4 scene 5, Petruchio and Katherina are on their manner Baptist # 8217 ; s place in Padua, and they stop for a remainder in the center of nowhere. Petruchio and Katherina argue over whether they see the Sun or Moon above them: Petruchio I say it is the Moon. Katherina I know it is the Moon. Petruchio Nay, so you lie. It is the blest Sun. Katherina Then, God be blessed, it is the blest Sun, But Sun it is non, when you say it is non, And the Moon alterations even as your head: What you will hold it named, even that it is, And so it shall be so for Katherine. ( IV.v.16-22 ) Katherina knows it is the Sun, non the Moon. However, if she disobeys what her hubby says, she can neer travel place. Then she decides to follow what he says. She recognizes at this point that alternatively of ever stating # 8216 ; no # 8217 ; , she can seek stating # 8216 ; yes # 8217 ; . It does non count to her whether she calls it the Sun or Moon because she has got nil to lose. Here she finds the manner to be comfy with Petruchio. Linda Bamber argues about this scene in her article called # 8220 ; Comic Women, Tragic Men # 8221 ; . # 8220 ; Kate has learned to keep her independency through dry hyperbole ; if Petruchio says it is the Moon, Kate knows it is the Moon # 8221 ; and # 8221 ; she feels blessed at holding eventually learned how to maintain a pocket of freedom for herself within the bounds of Petruchio # 8217 ; s rule over Kate # 8221 ; 8 Bamber says. Furthermore, # 8220 ; Kate is smart plenty to acknowledge to the full and eventually that mere nomenclature in itself is non deserving disputing over # 8221 ; 9 Richmond says. Harmonizing to Bamber and Richmond in this scene Katherina is being smart.10 She is non mer ely smart but adaptable every bit good. Richmond describes a good point of Katherina is that she can maintain her flexibleness even when her nurses are in rags. Actually, from the beginning of the drama she has shows her humor. In Act 2 scene1, when she meets Petruchio for the first clip, she answers fire with fire. On the other manus, Leggatt says, # 8220 ; here Katherina eventually displays the fruits of Petruchio # 8217 ; s instruction. Her obeisance is signalled by entry to her hubby on the most basic of affairs # 8221 ; .11 Is Katherina truly obedient to Petruchio in good religion? She seems to be moving an obedient married woman. Katherina has changed to be flexible, she is non obstinate any more? ? she is no longer a well-known # 8217 ; shrew # 8217 ; . At the terminal of the drama Katherina shows her obeisance to her hubby once more. Petruchio, Lucentio, and Hortensio play a game? ? they start wagering on their married womans. Each of work forces calls his married woman and they bet if their married womans obey their biddings. The hubby of the adult female who complies the biddings wins. First, Lucentio tells Biondello to take Bianca to Lucentio, but she replies she is busy so she can non come. Next, Hortensio calls Widow ; nevertheless, she does non come, and she even bids him to come to her. Finally, Petruchio calls Katherina and she shows up shortly. Petruchio tells Katherina to convey Bianca and Widow, and Katherina does that. She even instructs them how married woman as it ought to be, Thy hubby is thy Godhead, they life, thy keeper, Thy caput, thy crowned head: 1 that cares for thee, ? Such responsibility as the topic owes the prince, Even such, a adult female oweth to her hubby ; And when she is froward, cranky, dark, rancid, And non obedient to his honest will, What is she but a disgusting contending Rebel And graceless treasonist to her loving Godhead? I am ashamed that adult females are so simple To offer war where they should kneel for peace ; Or seek for regulation, domination, and sway When they are bound to function, love, and obey. ( V.ii. 147-148, 156-165 ) Now, Katherina is less powerful, less affluent, less cheerful? ? less everything than Petruchio. She loses herself, and she is non a individual as she was earlier. Petruchio # 8217 ; s taming of Katherina seems to be successful ; nevertheless Katherina has learned how to delight her hubby by his taming. Baptista and other work forces congratulate freely about Katherina # 8217 ; s growing at the terminal of the drama because her entry address has them believe that she has been wholly tamed and Petruchio dominates over Katherina. But, the fact of the affair is that Katherina has found the manner of populating non to be denounced her as a # 8217 ; shrew # 8217 ; . At the beginning of the drama, Katherina is obstinate and life as she pleases. Since she has met Petruchio, her behaviour and manner of thought has been altering. As Petruchio? s preparation is being in advancement, Katherina is seeking to acquire over his secret plan with her humor. The whole drama reasonably much focal points on Katherina. Many critics say that the drama is about Petruchio? s taming of Katherina, but she has non truly been tamed? ? she has changed the manner of showing herself. She changed people? s points of position toward her every bit good. The drama is non about chastening of Katherina, but a growing procedure of Katherina. Bibliography 1. Neely, Carol Thomas. Introduction. Broken Nuptials in Shakespeare? s Play. ( New Haven: Yale UP, 1985 ) , pp.21 2. Kahn, Coppelia. Men? s Estate. ( Barkley: Uracil of California P, 1981 ) , pp.104 3. Richmond, Hugh M. Shakespeare? s Sexual Comedy. ( Indianapolis: The Bobbs- Merill Co. Inc. , 1971 ) , pp.87 4. Evans, Faith, erectile dysfunction. Blatant Voices. ( New York: Routledge/Theatre Arts Book, 1989 ) , pp.8 5. Kahn, Men? s Estate, pp.108 6. Hibbard, G.R. Introduction. The Taming of the Shrew. ( Harmondsworth: New Penguin, 1968 ) , pp.21 7. Leggatt, Alexander. Shakespeare? s Comedy of Love. ( New Fetter Lane: Methuen A ; Co. Ltd. , 1974 ) , pp.56 8. Bamber, Linda. Comic Women, Tragic Men. ( Stanford: Stanford UP, 1982 ) , pp.35 9. Capital of virginia, Shakespeare? s Sexual Comedy, pp. 95 10. Bamber, Comic Women, Tragic Men, and Richmond, Shakespeare? s Sexual Comedy 11. Leggatt, Shakespeare? s Comedy of Love, pp. 58 3a9

SAT Results in Physics to Impress College Admissions

SAT Results in Physics to Impress College Admissions Because most colleges that ask for SAT Subject Tests are highly selective, you will most likely want a score in the 700s if youre going to succeed in impressing the admissions officers. The exact score is going to depend on the school, so this article will provide a general overview of what defines a good Physics SAT Subject Test score and what some colleges say about the exam. Subject Tests vs. the General SAT The percentiles for SAT Subject Test scores cant be compared to general SAT scores because the subject tests are taken by an entirely different student population. Because the test is required primarily by some of the nations top colleges and universities, the students who take SAT Subject Tests tend to be high achievers. The regular SAT, on the other hand, is required by a wide range of schools, including many that are not selective at all. As a result, the average scores for SAT Subject Tests are significantly higher than those for the regular SAT. For the Physics SAT Subject Test, the mean score is 664  (compared to a mean of about 500 for individual sections of the regular SAT).   While no tool exists for you to calculate your chance of admission based on the Physics exam, you can figure out your chance of admission based on your GPA and general SAT scores. What Subject Test Scores Do Colleges Want? Most colleges do not publicize their SAT Subject Test admissions data. However, for elite colleges, you will ideally have scores in the 700s. Here are what a few colleges say about the SAT Subject Tests: MIT: The Massachusetts Institute of Technologys admissions website states that the middle 50% of students scored between 720 and 800 on SAT II Subject Tests in the sciences.Middlebury College: The prestigious liberal arts college in Vermont claims that they tend to receive SAT Subject Test scores in the low to middle 700s.Princeton University:  This elite Ivy League school states that the middle 50% of admitted applicants averaged scores between 710 and 790 on their three highest SAT II Subject Tests.UCLA: As one of the top public universities, UCLA states that about 75% of admitted students scored between 700 and 800 on their best SAT Subject Test, and the average score for the best SAT Subject Test was 734 (675 for the second best subject).Williams College: Over half of matriculated students scored between a 700 and 800 on their SAT Subject Tests. As this limited data shows, a strong application will usually have SAT Subject Test scores in the 700s. Realize, however, that all elite schools have a holistic admissions process, and significant strengths in other areas can make up for a less-than-ideal test score. Your academic record will be more important than any test scores, especially if you do well in challenging college preparatory courses. Your AP, IB, dual enrollment, and/or honors courses will all play an important role in the admissions equation. Colleges will also want to see strong non-numerical evidence of your preparedness for college. A winning application essay, meaningful extracurricular activities, glowing letters of recommendation, and other factors can make an application stand out even when the test scores arent quite what you had hoped for. Very few colleges use the Physics SAT Subject Test to award course credit or to place students out of introductory level courses. A good score on the AP Physics exam, however, often will earn students college credit (especially the Physics-C exam). Physics SAT Subject Test Scores and Percentiles Physics SAT Subject Test Scores and Percentiles Physics SAT Subject Test Score Percentile 800 87 780 80 760 74 740 67 720 60 700 54 680 48 660 42 640 36 620 31 600 26 580 22 560 18 540 15 520 12 500 10 480 7 460 5 440 3 420 2 400 1 Data from the College Board Examine the correlation between Physics SAT Subject Test scores and the percentile ranking of students who took the exam. Nearly half of all people who took the exam scored a 700 or higher, a far bigger percentage than with the regular SAT. 67 percent of test takers scored a 740 or below on the Physics SAT Subject Test. In 2017, only 56,243 students took the Physics SAT Subject Test.

Power and Privilege Society and the Poor Essay Example | Topics and Well Written Essays - 750 words

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Discussions, week 1, week 2, week 3 Assignment Example | Topics and Well Written Essays - 500 words

Discussions, week 1, week 2, week 3 - Assignment Example To determine the cause of the itching, one should consider a history of the same symptoms. A dietary assessment is also required to determine if the skin reaction is due to an allergy. Certain drugs also cause allergic reactions. Lab tests may also be mandatory to establish if it is a microbial infection. Since the available information does not point to a specific condition, the patient should be treated for superficial infection and referred for further tests. A follow-up is necessary to assess the course of treatment (Wilson et al., 2013). Mr. AK has several chronic conditions that he is aware of and is receiving treatment. However, his recent loss of appetite and subsequent weight loss in the past few weeks is unexplained and could be as a result of several factors. His medical examination does not provide concrete evidence of the underlying cause. His dietary history points to certain factors that could have contributed to his current condition. AK takes wine every night before going to bed, which might be the main cause of his appetite loss. Alcohol has been shown to cause sleep disturbance (Ebrahim et al., 2013). It may reduce the time to fall asleep but prevents one from having a peaceful sleep. Also, alcohol reduces the appetite, and this can lead to unwanted weight loss. In the case of AK, the alcohol intake might be the main cause of his loss of appetite, weight loss, and daytime somnolence. As a treatment measure, he should be advised to avoid taking alcohol before going to bed and a follow up done to ensure he is complying. Facial itch can be caused by several factors. These include microbial infection, allergic reactions, skin diseases and facial hygiene among others. Chronic facial itch is usually as a result of dysfunction of itch sensing neurons that send false signals of pruritogenic stimuli to the brain (Oaklander, 2012). This condition is known as neuropathic itch, and usually does not involve direct

MRES7013 Essay Example | Topics and Well Written Essays - 3750 words

MRES7013 - Essay Example Thus, it is oxygenated in lungs, and de-oxygenated once it passes through tissues (Guyton and Hall, 2006 p. 78). Because of its liquid nature, it is able to seep through spaces once a vascular injury occurs. We usually see it as bruising of the skin, when trauma causes breakage in the thin-walled capillaries in the dermis. The bruising then recedes with time, and the skin goes back to its previous appearance as if nothing happened. The same may not be applicable to other organs, more notably the brain. Although there is no obvious bruising similar to that seen on the skin, brain hemorrhages present with more serious signs of paralysis or changes in the sensorium, as caused by the ischemia and neuronal death of the area in the brain that should have been perfused by the injured vessel. Soon, ischemia of some brain tissue results to irreversible neurologic dysfunction. Prompt management is thus needed before neurologic defects become permanent (Kumar et al., 2010, p. 41). The age of hemorrhage is important because it determines the management of intracranial hemorrhage, as will be discussed later. The stages of hematoma are based on the form of hemoglobin in RBCs. Initially, during the hyper-acute phase or hours after the development of the lesion, hematoma is made up ofa liquid suspension of intact RBCs containing oxy- or deoxy-hemoglobin. If the blood came from an arterial source, which is the case in most non-traumatic etiologies such as aneurysm, approximately 95% of hemoglobin molecules are oxygenated.Later, water is resorbed by the brain tissue, resulting to a solidified aggregation of RBCs. As the blood ages further, the hemoglobin denatures from oxy- ordeoxy- to met-hemoglobin. This transformation is dependent on the oxidation of ferrous (Fe+2) heme iron contained by oxy- and deoxyhemoglobin to ferric (Fe+3) state, turning the

Activities of Living Model Case Study

Activities of Living Model Case Study Assessment -> diagnosis -> plan -> intervention -> evaluation Section 1: Brief introduction to the person: (max 200 words) Anna is a 42 year old lady who has Rett syndrome and severe learning disability. Anna was born after a normal pregnancy. Anna has one brother and a sister who does not have learning disability or any specific health problems. Anna has been in the care for the last 11 years. Anna lived with her parents until 2001. Her mother used to be her primary carer. Currently Anna lives in a 4 bedroom bungalow with two other ladies, who also have learning disabilities. Part of social life she goes to the day service three days a week. She seems to enjoy up there. Anna enjoys listening to the radio while she is resting in her room. She can give an good eye contact when talk to her. To avoid a breach of confidentiality service user will be referred to as â€Å"Anna†, a pseudonym (NMC, 2008) Due to Anna’s severe learning disability and extremely limited communication skills she is unable to understand, retain or communicate an informed decision regarding consent to the contents of this assessment. In accordance with Mental Capacity Act (2005), following discussion with support staff, family and relevant health and social care professionals, this care plan is deemed to be in Anna’s best interests given the potential risks to her health and well-being. Section 2: 1000 WORDS Assessment based on Roper, Logan Tierney’s Activities of Living Model (1980). Some headings can be very brief if there are no specific issues for the person in that area of their life. Please also consider the age of the person and their level of independence / dependence for each area. Activities of Living The activities of living listed in the Roper-Logan-Tierney Model of Nursing are: 1. Maintaining Safe Environment Anna is dependent on staff to keep her safe. She exhibits bodily movements which interfere with normal safe eating and drinking. On occasions these erratic movements are so extreme as to put her at increased risk of physical injury. She can cause small wounds to her face, limbs and torso due to her repetitive stereotypical hand and arm movements. During the period of her erratic and uncontrolled movements put her at risk of aspiration and chocking. The uncontrolled movement can also cause lose some of her medication which is very essential for her physical wellbeing. When she settle after a seizure she is more likely to sleepy. During this time excessive production of saliva can affect her breathing / blocking the airway. Both Anna and staff are at risk of injury due to her flailing arms and legs. Also it is not safe to do the manual handling. When she displaying extreme body movements it not safe to transport her which can affect her attendance at day services. Anna’s dysphasia can increase the risk of aspiration and may can cause chest infection. Communicating Anna has no formalised system of communication through which to make her need/wishes known and is totally reliant on others to anticipate her needs. Even though she has very good eye contact. She has no active say regarding any aspect of her life. She is open to speech and Language Therapy services but this mainly for dysphasia. Communication and sensory integration assessment have been done in the past with very limited success (2011-12) Breathing Anna has abnormal breathing patterns which is common in Rett syndrome. Anna will show signs of shortness of breath which is causing her distress and/ or pain. Shortness of breath can lead to cyanosis. This most likely to occur after a prolonged seizure or when she has chest infection. If her oxygen saturation levels are reading below the usual baseline ie 93% or less Her range is 94-97%) oxygen is administrated as per prescribed. Eating and Drinking Anna has no functional use of her hand and she is fully depending on others to assist with her eating and drinking. She does eat and drink well, it seems she enjoy her meal. She has been assessed by the Speech and Language Therapy to be at the risk of aspiration. Anna has liquidised food and thickened drink. Anna has dysphasia which can contribute to an increased risk of coughing , chocking, aspiration and recurring respiratory tract infections Elimination Anna is unable to take herself to the toilet and has no formalised system of communication to alert others of her need to go to the toilet. Anna is incontinent of both urine and faeces with an associated potential for skin breakdown. Anna is prone to constipation. Personal Cleansing and Dressing Anna is unable to do her personal hygiene independently due to her complex health needs. Due to her erratic movements she cannot be bathed conventionally. She has had recent urinary tract infection, which may have been the result of faecal contamination of the vaginal area. At present Anna has the bed bath everyday with Aqueous cream (soap substitute) to help with her dry skin. Diprobase moisturiser is available as PRN for dry skin to prevent the risk of skin breakdown. Anna is unable to independently manage her oral hygiene needs and requires full support in this aspect of her care in order to maintain healthy teeth gums. Anna’s oral hygiene is maintained daily. Her positioning during and after oral hygiene procedures are important in order to minimise the risk of aspiration including silent aspiration. Controlling Body Temperature Anna’s normal temperature range for observations is 36-37.5*C. Anna can experience difficulty in maintaining an even body temperature and it is prone to becoming suddenly cold or hot. She prefers moderations in temperature. Staff need to be able to recognise when Anna is becoming too hot. Staff recognise breathing difficulties and cyanosis during prolonged seizures and use the prescribed oxygen via a face mask if necessary. Mobilising Anna is non-ambulant. She is unable to stand or support her own weight but she can hold head up when alert. She requires a back rest and bilateral support to be able to maintain an upright seated position. She has a full range of movement in all her limbs. Anna’s preferred positioning of her legs is to hold her knees tightly in flexion. Anna has apraxia and is unable to perform controlled motor movements. Working and Playing Anna attends day services for three full days a week. 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For this section you are asked to consider what may be causing or contributing to the health care need what signs and symptoms led you to this diagnosis. Possible aetiology (cause): Anna is a 41 year old lady who has Rett syndrome and severe epilepsy. Anna is totally dependent on others for all aspects of her care and has complex health needs that fluctuate and greatly impact on her day to day activities. These health issues are likely to affect the quality of her life. The most possible cause of Anna’s self injury caused of her extreme erratic body movement can be because of severe epilepsy. She suffers tonic-clonic seizures. Occasionally, post-seizure. She will present with peripheral cyanosis and this most noticeable around her lips, earlobes, and mouth and figure tips. Defining characteristics (signs symptoms): Epilepsy Anna displays an unusually high tolerance to external pain. When Anna sustains a trauma type injury (bruising / abrasions / shear injuries) there is no discernible visible reaction. Staff working with Anna require the ability to make visual assessments of her injuries and have understanding of the implications if the visual symptoms of injuries. There is a risk that the severity of physical injuries may under assessed resulting in treatment mismanagement. It is believed that Anna does react to internal type pain such as menstrual pain, constipation or stomach pain. Anna experiences seizures of varying length and intensity. She used to experience on average 10-15 seizures each month but this had increased to daily seizures. Seizures can occur at any time during the day and night, but there is evidence to suggest that she prone to epileptic activity when asleep. Therefore, she has an alarm monitor which is under trial, whereby noises which accompany seizures activated a pager which the nurse can carry. She remains under the out-patient care of her consultant Neurologist (seen every 6-8 months). Video analysis is available to help diagnose exact seizure presentation and appropriate medical intervention. The use of rescue medication has also increased. She requires rectally administered diazepam for the treatment of status epilepticus. Suction may be required to control oral excretions and administration of oxygen via face mask may be necessary in the event of cyanosis. Buccal Midazzolam has been trialled in the past and although effective in halting the seizure activity, Anna went into status within hours (2006) or her clinical signs dipped significantly (2012). This was found to not be the case with Rectal Diazepam. Anna’s behaviour can be changed after a seizure activity. She will have very uncontrolled body movements mainly with hands and legs. The medication she have to control her seizure can make her depressed. Anna is on medication that required serum blood testing to ensure safe therapeutic levels and prevention of toxicity. This is believed to have occurred as recently as 2011 when Levetiracetam was believed to have caused her dangerous agitation (dose was 1500mg BD at that time). The following factors are known to reduce Anna’s seizure threshold: Menstruation Overheating Over-excitement When she is not well Constipation Anna has regular menstrual cycle. She can experiencedysmenorrhoea. She will have a loose bowl motions during her menstrual cycle. Anna also exhibits other events that may be mistaken for seizure activity: Hyperekpexia Eye – rolling Rett syndrome characteristics (jerks, tics) Section 4: People with complex health care needs often have a number of other non-nursing professionals working to help restore or maintain their health. Please discuss the contribution another profession has made to the assessment and their therapeutic interventions with the individual. Due to Anna’s difficulty in eating and drinking ( mainly during her extreme erratic body movements) she was referred to the speech and Language Theraphist ( SALT ). Anna has been assessed by Speech and Language Therapy to reduce the risk of aspiration / silent aspiration when eating and drinking. According to the SALT Anna has been diagnosed with dysphasia (SALT report, 2011). She is at risk of aspiration of food and fluids, as these do not always clear from her oropharyngeal cavity during meals. The SALT visited Anna at home and gathered all the information about her eating and drinking difficulties from the staff. Assessment has consisted of observation of mealtimes, discussed with staff and monitor at meal times by staff. Speech Language therapist made referral for videofluoroscopy assessment in 2012. After the videofluoroscopy SALT advised to give mouthful of drink in-between her meal. Coughing charts were implemented for both eating and drinking between initial assessment and review. The charts indicated that Anna was coughing when eating and drinking. The recommendations made by Speech and Language Therapy was to avoid mixed textures i.e. soup and stews with bits or high risk of lumpy food. And replace these with a soft alternative, or liquidised soups. It can help her to prevent the risk of aspiration pneumonia. When Anna has liquidised food it is very important to make sure there are no lumps. For example, mashed potato is very likely to have lumps which may cause chocking. Speech and Language therapy also recommended Anna must have a drink with any meal, and mouthfuls of drink must be given during the meal. It is helping her to clear her airway and to enjoy the meal. Anna should not to be fed when she is sleepy or drowsy as fatigue can result in an increased risk of aspiration. If Anna showing extreme bodily movement when the meal or drink is to take place, the second carer is to place themselves at the side of her, and using their forearm, palm facing downwards. Use a blocking technique to lower Anna’s arms down to her lap and gently rest their palm and dingers together on her further chest long bone. While feeding Anna it is very essential the staff to sit on a chair and make sure she is able to give an eye contact. Anna must be seated in her day chair when having meal. Staff need to ensure that Anna is in an upright position. After the assessment done by SALT has also noted the aspiration can also because of the remaining food / drink in her mouth. To rid of that SALT recommended giving her an oral care after food fluid intake. By using a very soft toothbrush to clean the mouth can minimise risk or aspiration due to food fluid residue. And also it is important to maintain upright position for at least 30 minutes after having mouth care to reduce t he possibility of reflux. The recommendations from SALT is likely to help Anna to enjoy her meal. Her dysphasia techniques are continuing as it is recommended this will help to maintain the swallowing difficulty. Staff can contact the SALT if there is any new difficulty in eating and drinking and SALT will do the follow up / regular visits. Nancy Jimmi

Infant Mortality Within the United States Essay -- Babies Birth Pregna

Infant Mortality Within the United States Herein I briefly overview the Infant Mortality Rate (IMR) within the United States. Initially, I discuss specific causes of infant death and then, contributing factors which put babies at risk. Next, the distribution of various IMR is surveyed on a state to state basis. States possessing the ten highest infant mortality rates are discussed, including possible reasons for higher IMR. In addition, those states with the ten lowest IMR are mentioned. In conclusion, I consider preventative measures for minimizing the number of babies that die each year. Return to Table of Contents Introduction Every eight seconds a baby is born in the United Sates (U.S.), and within one hour four babies die (1). The infant mortality rate (IMR) measures the rate at which babies die before their first birthday and is calculated per 1,000 live births. According to government figures 7.2 babies out of every 1,000 born in 1996 died (2, p 6). Although this figure declines steadily each year and is 406% lower than the 1950 figure (3) the United States IMR is still higher than twenty four other nations (1). More importantly, the IMR for black U.S. citizens is over twice the rate of white citizens (6.3 and 14.6 respectively) (4, p 9). The National Commission to Prevent Infant Mortality even calls some regions "disaster areas" (5, p 18). What are the leading causes of infant death, and what areas within the United States are most affected? What preventative measures can ensure a child its first birthday? These questions are addressed herein. In addition, certain National Standards f or Geography are met. Return to Table of Contents Applicable National Standards In 199... ... Rawlings, James S.; Rawlings, Virginia B.; Read, John A. "Prevalence of Low Birthweight and Preterm Delivery in Relation to the Interval between Pregnancies among White and Black Women." The New England Journal of Medicine, Vol 332, No 2, 1995, p 69-75. Scott, J. "Black Infant Death Rate 2 Â ½ Times That of Whites." Los Angeles Times, 1991 Nov 15, 110 (347), A35. Steinbrook, R. "Black Infant Deaths Tied to Birthweight." Los Angeles Times, 111 (184), 4 Jun 1992, A26. "Ten Leading Causes of Infant Mortality," Infant Health Statistics. 1997. http://www.mofimes.org/stats/ten.htm (11 April 1998). Ventura, Stephanie J.; Kimberley D. Peters; Joyce A. Martin; Jeffrey D. Maurer. Monthly Vital Statistics Report, Vol.46, No. 1 Supplement 2, 11 Sept. 1997, p 6. http://www.cdc.gov/nchswww/products/pubs/pubd/mvsr/supp/46-45/46-45.htm (11 April 1998).