Blackadder Goes Forth and Journey’s End Essay

The ending scene for both Journey’s End and Black Adder Goes Forth are similar and different in many ways. For example, the last episode of Black Adder Goes Forth greatly affects the viewer by pursuing the idea that history as it was written and has been taught is incorrectly. In having this approach, it is like the audience is rediscovering history and uncovering the truth of our ancestors for the first time. Not only does this capture the viewer’s attention, but it entertains them as well as touching them on an emotional and comedic level by showing the real life orders trench’s but deliberately miss hearing what the orders were. Viewers, however, also know that these orders are not to be taken seriously and are only there for the comedy value. An example of this is when one soldier states that the reason for the war was because someone shot an ostrich out of hunger. The majority of viewers know this is not true, but the episode and character plays the comic seriousness to perfection. However, Journey’s End shows the more serious side of the war and trench life by being a serious side of the war and trench life by being a serious play with no real comedic value. One soldier is very excited about the idea of defending his country; in fact he is so honoured by this chance, that he does not accept a way out of the trenches when he is offered; even though Blackadder realizes their fate when the go above the trenches and tries to explain he will die. I never imagined anything as awful as war† this also shows the serious nature that war has on its soldiers, this is also shown when another soldier states that he wants the dying to stop, and everyone to go home, because he cannot see a reason for war, this links in Sassoon’s declaration where he states war has gone from one of â€Å"defence and liberation† to one of â€Å"aggression and conquest†. Even George has to try and push these thoughts out of his mind and replace them with thought s of patriotism and the great honour dying for ones county has. This is much like Raleigh in Journey’s End when he first enters the battalion and his innocence is intact because he does not know the true horrors of war yet. Act three scene three of Journey’s End is the very last scene of the play. From almost the very beginning we have known that an attack from the German opposition is inevitable. However, the character in the play are not sure when it will take place or what form it will take place in, as the attack could happen in any moment meaning the ension is high throughout and especially in the final scene. This is not the only tension in the script. At the beginning of act three scene three, Raleigh and Stanhope, two of the most prominent characters, have had a large argument about the death of a mutual friend, which is not resolved until the beginning of the final scene. The strain on their relationship has been tense for the duration of the play and was heightened by the hero worshipping Raleigh did for Stanhope. As they were previously well acquainted before they were both in the battalion Stanhope fears that Raleigh would look at him badly and tell people on the home front what he has become, an alcoholic, and Stanhope chooses to ignore their previous relationship and address him as a new Officer. This contrasts with Blackadder Goes Forth, because as Colonel Melchett knows George he uses this to his advantage by manipulating him into showing propaganda to the men; however Colonel Melchett also has an underlying theme of worry for George and seems to offer him many ways out of fighting the war because he knows his death is inevitable. To conclude I feel that Blackadder Goes Forth and Journey’s End and two completely different plays. However, they both share few similar themes, for example they both share the theme of hero worship, where soldiers look o authority figures for guidance which again opposes the view that Sassoon has on the war. They also share the theme of waiting, because both plays are waiting to ‘go over the top’ and neither plays want to because they know that your death was sure if you do so due to the heavy equipment the Germans have. Although, I believe Journey’s End is much more a serious play whereas Blackadder Goes Forth uses comedy and takes from the impact it could truly have if it was more realistic to trench life, but it still shows the fear and anger of many men when regarding the war.

Importance Of High School Sports

?Many people do not realize the importance of high school sports; let me tell a story. There were two completely different kids that went to the same high school. One of them participated in high school sports from Fall to Spring. This kid kept up with his grades and kept busy with sports and homework. The other kid did not participate in any kind of school sports. The kid who didn’t play any sports went home after school every day, so instead of playing sports or doing homework in the free time available, he had to find something else to keep busy. Having all this free time led trouble.There is no need to go into more depth in the story; the point is that people do not realize that high school sports are a crucial part of being a good student and becoming a successful adult. â€Å"The evidence supporting sports participation for young people is overwhelming†¦ It has the power to combat everything from racism to low self-image, to the high-school drop-out rate† (Ca stle). One of the many benefits of playing high school athletics is that the Student has to sign a code of conduct that will keep the student athlete responsible for his or her actions.â€Å"1) Use or possession of tobacco products. 2) Being present more than 5 minutes at a function where alcohol and/or drugs are being consumed/used or have been consumed or used. 3) Use or possession of intoxicating beverages and illegal drugs or drug paraphernalia. 4) Committing unlawful acts that have or could have resulted in a misdemeanor or higher penalty. 5) Serious and/or repeated violation of school rules. 6) Serious and/or repeated unsportsmanlike conduct. † This is a list of the rules that must be strictly followed in order to participate in a sports team at Nooksack Valley High School.If any of these rules are broken during season the athlete is penalized by being ineligible to play for 60% of the season. If the code is violated during the off-season, the penalty is disqualificatio n for 40% of the season. Athletes that take their sport seriously, and hope to move on to a collegiate level know that missing 40% to 60% percent of a season will hurt their chances of being scouted substantially. The risk taken by breaking the athletic code is not worth losing a chance of a scholarship to continue playing a sport a student loves at a competitive level.The Sumner School District has a great way of explaining the code of conduct to the community. â€Å"This activities code is designed to establish a reasonable, high standard for participants in co-curricular activities that empower our participants to make appropriate decisions, rather than to be punitive and deny access to such activities. Co-curricular activities are a privilege and completely voluntary. Along with this privilege comes the expectation of a higher standard of behavior and conduct.Participants in these activities are considered to be in positions of leadership representing themselves, their families , the team, school, district and community† (Sumner Athletics). This brief blurb from the Sumner Athletics Code of Conduct represents the higher standard athletes, actors, singers, dancers, and all participants of extracurricular activities are held to. Being involved in sports does not only reflect the athlete, but is a representation of the entire student body and staff members.The responsibility of athletes to uphold this good reputation is one of the main reasons student athletes are proven to perform better in school, and stay out of trouble. Being a student athlete in high school does not only keep the student responsible, it also provides physical activity for students who have been sitting in the classroom all day. Not only does physical activity contribute to a healthy body weight and prevention of heart disease and type 2 diabetes, but also shows astounding benefits in academic performance and lowering depression.Penny McCullagh, a psychologist, found in her research that exercise has the ability to work like an anti-depressant. McCullagh states, â€Å"The most common treatments for depression, for example, are psychotherapy or medication. Psychologists have found that exercise is a third successful alternative† (McCullagh). The article states the best results to help depression comes when a combination of exercise and psychotherapy happens together. The physical exercise from sports also helps brain function.â€Å"According to a study done by the Department of Exercise Science at the University of Georgia, even briefly exercising for 20 minutes facilitates information processing and memory functions† (Physical Exercise for Brain Health). Just the exercise alone from sports is already helping with depression, brain functions, or just staying fit and in shape. There are many studies with evidence to support the benefit exercise has in the classroom. â€Å"Researchers at Saginaw Valley State University in Michigan tracked the grade s and exercise habits of 266 undergraduates.It was found that students who regularly participate in vigorous physical activity had higher G. P. A. ’s† (Parker-Pope). Regular exercise has a tremendous effect on the brain, especially in the high school years when it is still developing. Along with these benefits, being part of a sports team influences attitudes on and off the court or field. Student athletes are proven to have a stronger sense of leadership, motivation, and work ethic than their peers who do not participate in after school activities. Belonging to a team or club creates a drive in students to succeed in all aspects of life.Many Americans today are suffering from being obese or overweight. According to the American Heart Association, â€Å"23. 9 million children ages 2 to 19 are overweight or obese; 33. 0% of boys and 30. 4% of girls† (Overweight & Obesity – 2013 Statistical Fact Sheet). That means almost two thirds of all the Americans are a t an unhealthy weight. According to Centers for Disease Control, obesity brings in $147 billion in healthcare costs per year. There are many different causes for obesity such as stress, inactivity, and depression.There is one simple solution to decrease the amount of obese adults and children in America. Playing sports helps with all three of the problems. Habits are formed at a young age, so if sports are a part of a lifestyle as a young child, they will most likely be a part of their future. When some people think about exercise, they instantly think boring, tedious, painful workouts in an over packed gym. What most people don’t know is that exercise can be fun! All it takes is the motivation to get off the couch. Exercising with others increases the chance that you will stick with it.Sports teams are the ultimate example of this. When a support system is built in, with the drive to not let your teammates down, the motivation to be physically fit comes naturally. People arg ue that playing sports leaves no time for homework. However, there is a system at Nooksack Valley High School called study table. Study table is an hour long class where any missing homework can be complete before school. This system was made to give extra help to kids that are failing classes while playing sports. Nooksack Valley’s athletic director, Tom Harmon, checks the grades of each student athlete every Sunday.If any students are failing a class a study table is assigned each morning for the entire week. If the student is failing more than one class then they are not allowed to participate in any games or tournaments held that week. The phrase â€Å"student before athlete† is commonly used among coaches and staff members. Being a successful student is far more important than making touchdowns or scoring goals. Student first, athlete second is the only way to ensure students are prepared for higher education or entering the work force after graduation.Some people may argue that high school sports need to be cut due to lack of funding. Personally, I think without the opportunity to participate in sports students will lack the development of very important life skills. From experience, players can say that being a member of a high school sports team has taught them how to work hard for what they want, how to step up and be a leader, and how to communicate with others and be a team player. These skills and personality traits are all things that future employers are looking for when making hiring decisions.Managers know that people who have grown up being involved in sports teams and clubs are trained to work well with others, and have a strong work ethic. Marty Brounstein lists ten qualities of an effective team player as the ability to demonstrate reliability, communicate constructively, listen actively, function as an active participant, share openly and willingly, exhibit flexibility, show commitment, work as a problem solver, and, finally, treat others with respect and support. â€Å"Team players with commitment look beyond their own piece of the work and care about the team's overall work.In the end, their commitment is about winning — not in the sports sense of beating your opponent but about seeing the team succeed and knowing they have contributed to this success. Winning as a team is one of the great motivators of employee performance. Good team players have and show this motivation† (Brounstein). In conclusion, being actively involved in high school sports shows success on and off the court or field as well as in future career choices. Participation in sports teams is not only beneficial while in high school but in all stages of life.Skills learned from coaches and teammates can be applied in meeting new friends in college, at job interviews, and in many other instances. â€Å"We have data indicating sports and other extracurricular activities do better than academic classes in teaching leadershi p, teamwork, time management and other skills crucial for success in the workplace† (Mathews). While some may say that high school athletics need to be cut because the money spent on them could be put to better use, the evidence of many studies proves this statement to be false.Without the opportunity to be a part of a team or club, students lose out on a great learning experience that acts as a foundation for the rest of their lives. The ability to manage being a successful student as well as a good athlete takes a special skill that is developed during the high school years. There needs to be a balance between academic and athletic commitment. A student’s high school career cannot only be based on one or the other. It needs a combination of the two in order for the student to reach full potential.Michael Jordan is one of the most inspiring athletes to kids around the world. He often stems his success back to his experiences with high school sports. I believe it is sto ries like his that demonstrate the importance of being involved in sports teams, and the life lessons that are learned throughout the experience. A famous quote from Jordan states, â€Å"I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed. † Importance of High School Sports Many people do not realize the importance of high school sports; let me tell a story. There were two completely different kids that went to the same high school. One of them participated in high school sports from Fall to Spring. This kid kept up with his grades and kept busy with sports and homework. The other kid did not participate in any kind of school sports. The kid who didn’t play any sports went home after school every day, so instead of playing sports or doing homework in the free time available, he had to find something else to keep busy. Having all this free time led trouble.There is no need to go into more depth in the story; the point is that people do not realize that high school sports are a crucial part of being a good student and becoming a successful adult. â€Å"The evidence supporting sports participation for young people is overwhelming†¦ It has the power to combat everything from racism to low self-image, to the high-school drop-out rate† (Cas tle). One of the many benefits of playing high school athletics is that the Student has to sign a code of conduct that will keep the student athlete responsible for his or her actions.â€Å"1)Use or possession of tobacco products. 2) Being present more than 5 minutes at a function where alcohol and/or drugs are being consumed/used or have been consumed or used. 3) Use or possession of intoxicating beverages and illegal drugs or drug paraphernalia. 4) Committing unlawful acts that have or could have resulted in a misdemeanor or higher penalty. 5) Serious and/or repeated violation of school rules. 6) Serious and/or repeated unsportsmanlike conduct. † This is a list of the rules that must be strictly followed in order to participate in a sports team at Nooksack Valley High School.If any of these rules are broken during season the athlete is penalized by being ineligible to play for 60% of the season. If the code is violated during the off-season, the penalty is disqualification for 40% of the season. Athletes that take their sport seriously, and hope to move on to a collegiate level know that missing 40% to 60% percent of a season will hurt their chances of being scouted substantially. The risk taken by breaking the athletic code is not worth losing a chance of a scholarship to continue playing a sport a student loves at a competitive level.The Sumner School District has a great way of explaining the code of conduct to the community. â€Å"This activities code is designed to establish a reasonable, high standard for participants in co-curricular activities that empower our participants to make appropriate decisions, rather than to be punitive and deny access to such activities. Co-curricular activities are a privilege and completely voluntary. Along with this privilege comes the expectation of a higher standard of behavior and conduct.Participants in these activities are considered to be in positions of leadership representing themselves, their families, the team, school, district and community† (Sumner Athletics). This brief blurb from the Sumner Athletics Code of Conduct represents the higher standard athletes, actors, singers, dancers, and all participants of extracurricular activities are held to. Being involved in sports does not only reflect the athlete, but is a representation of the entire student body and staff members.The responsibility of athletes to uphold this good reputation is one of the main reasons student athletes are proven to perform better in school, and stay out of trouble. Being a student athlete in high school does not only keep the student responsible, it also provides physical activity for students who have been sitting in the classroom all day. Not only does physical activity contribute to a healthy body weight and prevention of heart disease and type 2 diabetes, but also shows astounding benefits in academic performance and lowering depression.Penny McCullagh, a psychologist, found in her research t hat exercise has the ability to work like an anti-depressant. McCullagh states, â€Å"The most common treatments for depression, for example, are psychotherapy or medication. Psychologists have found that exercise is a third successful alternative† (McCullagh). The article states the best results to help depression comes when a combination of exercise and psychotherapy happens together. The physical exercise from sports also helps brain function.â€Å"According to a study done by the Department of Exercise Science at the University of Georgia, even briefly exercising for 20 minutes facilitates information processing and memory functions† (Physical Exercise for Brain Health). Just the exercise alone from sports is already helping with depression, brain functions, or just staying fit and in shape. There are many studies with evidence to support the benefit exercise has in the classroom. â€Å"Researchers at Saginaw Valley State University in Michigan tracked the grades and exercise habits of 266 undergraduates.It was found that students who regularly participate in vigorous physical activity had higher G. P. A. ’s† (Parker-Pope). Regular exercise has a tremendous effect on the brain, especially in the high school years when it is still developing. Along with these benefits, being part of a sports team influences attitudes on and off the court or field. Student athletes are proven to have a stronger sense of leadership, motivation, and work ethic than their peers who do not participate in after school activities. Belonging to a team or club creates a drive in students to succeed in all aspects of life.Many Americans today are suffering from being obese or overweight. According to the American Heart Association, â€Å"23. 9 million children ages 2 to 19 are overweight or obese; 33. 0% of boys and 30. 4% of girls† (Overweight & Obesity – 2013 Statistical Fact Sheet). That means almost two thirds of all the Americans are at an unhealthy weight. According to Centers for Disease Control, obesity brings in $147 billion in healthcare costs per year. There are many different causes for obesity such as stress, inactivity, and depression.There is one simple solution to decrease the amount of obese adults and children in America. Playing sports helps with all three of the problems. Habits are formed at a young age, so if sports are a part of a lifestyle as a young child, they will most likely be a part of their future. When some people think about exercise, they instantly think boring, tedious, painful workouts in an over packed gym. What most people don’t know is that exercise can be fun! All it takes is the motivation to get off the couch. Exercising with others increases the chance that you will stick with it.Sports teams are the ultimate example of this. When a support system is built in, with the drive to not let your teammates down, the motivation to be physically fit comes naturally. People argue that playing sports leaves no time for homework. However, there is a system at Nooksack Valley High School called study table. Study table is an hour long class where any missing homework can be complete before school. This system was made to give extra help to kids that are failing classes while playing sports. Nooksack Valley’s athletic director, Tom Harmon, checks the grades of each student athlete every Sunday.If any students are failing a class a study table is assigned each morning for the entire week. If the student is failing more than one class then they are not allowed to participate in any games or tournaments held that week. The phrase â€Å"student before athlete† is commonly used among coaches and staff members. Being a successful student is far more important than making touchdowns or scoring goals. Student first, athlete second is the only way to ensure students are prepared for higher education or entering the work force after graduation.Some people m ay argue that high school sports need to be cut due to lack of funding. Personally, I think without the opportunity to participate in sports students will lack the development of very important life skills. From experience, players can say that being a member of a high school sports team has taught them how to work hard for what they want, how to step up and be a leader, and how to communicate with others and be a team player. These skills and personality traits are all things that future employers are looking for when making hiring decisions.Managers know that people who have grown up being involved in sports teams and clubs are trained to work well with others, and have a strong work ethic. Marty Brounstein lists ten qualities of an effective team player as the ability to demonstrate reliability, communicate constructively, listen actively, function as an active participant, share openly and willingly, exhibit flexibility, show commitment, work as a problem solver, and, finally, t reat others with respect and support. â€Å"Team players with commitment look beyond their own piece of the work and care about the team's overall work.In the end, their commitment is about winning — not in the sports sense of beating your opponent but about seeing the team succeed and knowing they have contributed to this success. Winning as a team is one of the great motivators of employee performance. Good team players have and show this motivation† (Brounstein). In conclusion, being actively involved in high school sports shows success on and off the court or field as well as in future career choices. Participation in sports teams is not only beneficial while in high school but in all stages of life.Skills learned from coaches and teammates can be applied in meeting new friends in college, at job interviews, and in many other instances. â€Å"We have data indicating sports and other extracurricular activities do better than academic classes in teaching leadership, teamwork, time management and other skills crucial for success in the workplace† (Mathews). While some may say that high school athletics need to be cut because the money spent on them could be put to better use, the evidence of many studies proves this statement to be false.Without the opportunity to be a part of a team or club, students lose out on a great learning experience that acts as a foundation for the rest of their lives. The ability to manage being a successful student as well as a good athlete takes a special skill that is developed during the high school years. There needs to be a balance between academic and athletic commitment. A student’s high school career cannot only be based on one or the other. It needs a combination of the two in order for the student to reach full potential.Michael Jordan is one of the most inspiring athletes to kids around the world. He often stems his success back to his experiences with high school sports. I believe it is stori es like his that demonstrate the importance of being involved in sports teams, and the life lessons that are learned throughout the experience. A famous quote from Jordan states, â€Å"I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed. †

Pathophysiology Paper

Running Head: Integrated Pathophysiology Integrated Pathophysiology Paper Confidential RNSG 2463 Instructor Date Integrated Pathophysiology 2 Patient Data Mr. F. is a seventy-three year old Caucasian male who is twice divorced and lives alone in Sweetwater, Texas. He has two children living, and two deceased children. Both of his parents are deceased; his father died at the age of sixty-nine of prostate cancer, his mother at the age of seventy-two of a stroke. He is self-employed, owning a local dirt contracting company for about thirty years now. Mr. F. tands five-foot and nine inches tall and weighs two hundred sixty pounds, exhibiting moderate obesity and has been for the past twenty-five years. He has a longstanding history of hypertension; approximately twenty years as well as a history of diabetes mellitus type two for twelve years, never having been insulin dependant. He has a smoking history of about fifty years smoking two packs per day and has been diagnosed a few years ago with chronic obstructive pulmonary disease, making him oxygen-dependant for two years. He claims to only drink alcohol on a social basis.Prior to his current admission, he stated that he has not been compliant with his diabetic diet, that he does not check his blood glucose regularly nor has he been following his medication regimen as he should. His last doctors appointment was two years ago. On July 6, 2008, Emergency Medical Services was called to Mr. F. ’s residence by a friend who found him in bed, conscious, but speaking incoherently. He had a nasal canula in place at three liters per minute. His glucometer done by emergency personnel showed a blood sugar of thirty-six.He was then given a bolus of dextrose fifty percent; he then returned to consciousness, but complained of some right arm and leg weakness. He had 3+ pitting edema bilaterally to lower extremities as well as 1+ presacral edema. He was then transported to Rolling Plains Memorial Hospital emergency room. Upo n arrival to the hospital, his vital signs were as follows; blood pressure- 200/103, heart rate- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per minute. His right sided weakness seemed to resolve per patient.He denied headache, vertigo and tinnitus. Diagnostics done at the emergency room showed a white blood cell count of 7. 8, hemoglobin of 12. 4, hematocrit of 37. 2, MCV of 95, and the platelet count along with coagulation studies showed to be normal. His renal function was abnormal at a BUN of 68 and a creatinine of 6. 1. His potassium level was 5. 4 and CO2 was 22. 3. His sodium level was 133, phosphorus levels were elevated at 6. 1, globulins were elevated at 4. 3, troponin level was slightly elevated at 0. 14 and CPK was normal. His BNP NT-Type was extremely elevated at 9674. along with his hemoglobin A1C was at 5. 8. Thyroid studies were Integrated Pathophysiology 3 found to be normal. The total cholesterol was 127, with HDL only at 24, LDL at 79 and triglycerides at 136. A further diagnostic study revealed by way of chest x-ray has shown cardiomegaly with mild venous congestion. The EKG shows poor R wave progression and nonspecific ST wave changes from previous. The echocardiogram showed 2+ mitral valve regurgitation with mild aortic stenosis and also an ejection fraction of over 50%. A renal sonogram shows diffuse cystic changes.A CT scan of his head revealed mild white matter changes but no other abnormalities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190. 3. The patient denied problems with urination such as frequency, urgency, dysuria, recurrent urinary tract infections or renal stones. Home medications included; Potassium chloride 10 mEq t. i. d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b. i. d. for a total of 20 mg daily, Albuterol inhaler, Furosemide 80 mg in the am and 40 mg in the pm. Mr. F. was admitted into the intensive care unit from the emergency room.Diseases/Pathophysiology Mr. F. ’s current disease processes are long-standing hypertension, obesity, COPD, Diabetes mellitus, chronic renal failure, and congestive heart failure. Hypertension is defined as a blood pressure greater than 140/90 mm Hg (Ignatavicius & Workman, 2006). It is caused by increases in cardiac output, total peripheral resistance, or both. The cardiac output is the volume of blood that is ejected by the heart each minute. Peripheral resistance is a resistance to the flow of blood out side of the heart. It can be considered either primary or secondary.Primary hypertension has no known causative factors other than relation to genetic predisposition, obesity, stress, increased alcohol intake, diabetes, and or sodium and water retention in which all increase the total workload of the heart and increase fluid volume with in the vascular space (Zerwekh, Claborn & Gaglione, 2006). Secondary hypertension is elevated blood pressure with a n identifiable cause that may include but not limited to; renal stenosis, congenital heart defects, Cushing’s syndrome, pheochromocytoma, untreated sleep apnea, MAOIs, chemical stimulants such as cocaine, methamphetamines etc. or pregnancy induced (Zerwekh, Claborn & Gaglione, 2006). Obesity is a disease within many diseases with many varying causes. According to Ignatavicius and Workman (2006), an obese person weighs at least 20% above the upper limit of the normal range for ideal body weight and refers to an excessive amount of body fat in which can be distributed differently and cause an array of problems according to the distribution, Integrated Pathophysiology 4 especially android obesity with excess fat at the waist and abdomen; this pattern carries the greatest health risk.Chronic Obstructive Pulmonary Disease is a progressive and irreversible condition characterized by diminished inspiratory and expiratory capacity of the lungs (Mosby’s, 2002). Emphysema along with chronic bronchitis is complications that lead to COPD. The etiology is more often than not, a long history of smoking cigarettes or other forms of smoking tobacco. The lungs lose elasticity and tend to cause hyperinflation due to the alveoli in the lung losing its elastin, in which then narrows and produces a surface area that decreases and is no longer functioning properly for adequate gas exchange.The accumulated air that is unable to be absorbed properly becomes trapped and causes the collapse of the smaller airways called bronchioles. With the lungs hyperinflated, this flattens the diaphragm, thus causing the individual to utilize accessory muscles to breath, increasing the respiratory rate to compensate. Patients with COPD have bouts with chronic bronchitis which is an inflammation of the bronchi and bronchioles triggered usually by tobacco smoke.The irritants from the smoke cause inflammation, with vasodilation, mucosal edema, and bronchospasms; the increased inflammation increases the size of the mucosal glands and produce large amounts of thick mucus, causing the bronchial walls to thicken and impair airflow (Ignatavicius & Workman, 2006). Diabetes Mellitus comes in many forms; the main characteristic is elevated blood glucose due to complications in the insulin secretion or action or both (Ignatavicius & Workman, 2006).When diagnosed with diabetes other than type one, the beta cells in the islets of Langerhans that produce insulin and the alpha cells that produce glucagon, which counteract one another, either decrease in production of these hormones or can possibly produce at a normal balance. If there is normal production of these hormones, mainly insulin (the hormone that transports glucose into the cells), it is usually cellular resistance to insulin that is causing the diabetes.When the cells are not receiving the necessary glucose needed for cellular function and metabolism, the body is unable to utilize the glucose, store carbohydrates, fat s and proteins; therefore the unused glucose remains in the blood causing hyperglycemia and regulatory mechanisms in the body tend to cause the release of more glucagon which cause the release of stored glucose in the liver into the bloodstream as well, therefore increasing the blood glucose level even more. Homeostasis is Integrated Pathophysiology 5 nterrupted, systemically causing damage. The etiology of type two diabetes can be a combination of many factors; however the well known contributor is obesity. Chronic renal failure is a progressive, irreversible kidney injury, and kidney function does not recover (Ignatavicius & Workman, 2006). The kidneys are in charge of filtering the metabolic wastes in the bloodstream that comes from cellular metabolism throughout the body as well as reabsorption of necessary electrolytes.When long-term damage is sustained in the cells of the kidneys (nephrons) by factors such as longstanding hypertension, function is progressively altered exhibit ed by the inability to excrete the nitrogenous wastes; therefore they accumulate in the kidneys and blood stream. Altered glomerular filtration rate, abnormal urine production, poor water excretion, electrolyte imbalances, and metabolic abnormalities occur as a result of renal failure. The body’s ability to dilute urine is decreased; therefore urine output decreases causing fluid overload.The failure occurs in stages with the last being end-stage renal disease in which all renal function eventually ceases. Congestive heart failure also known as left-sided heart failure may result from hypertensive coronary artery and valvular diseases arising particularly from the mitral and aortic valves. When CHF occurs from any etiology such as systemic hypertension and structural changes, the ventricles of the heart are unable to contract and or relax properly causing blood to congest around the heart.As a result of this congestion in and around the heart, tissue perfusion diminishes and blood accumulates in the pulmonary vessels. Cardiac output eventually decreases and compensatory mechanisms such as sympathetic nervous system stimulation, the renin-angiotensin system activation in the kidneys (RAS), other neurohumoral responses and myocardial hypertrophy will occur (Ignatavicius & Workman, 2006).The hypoxic state of the tissues stimulate the nervous system which increases the heart rate and blood pressure due to vasoconstriction and this stimulation increases venous blood return to the heart, which in turn stretches the myocardial fibers causing dilation and eventually thickening of the walls of the heart and chambers within it, consequently causing enlargement (cardiomegaly). The heart then tries to contract harder and eventually exhausts and reduces the force of the contractions; therefore decreasing cardiac output.The vasoconstriction of the arteries increases the afterload which is the resistance that the heart must pump. This low output causes a decrease in b lood flow to the kidney’s which results in the activation of the RAS in turn causes sodium and water retention. Cardiac preload and afterload increase causing contractile dysfunction. Integrated Pathophysiology 6 Integration Mr. F. reported that he has been obese for approximately twenty-five years. A few years after the significant weight gain, he was diagnosed with hypertension.At his own admission, his lifestyle of high fat, cholesterol, salt and sugar intake as well as a long history of smoking cigarettes left little to be desired and have contributed significantly to his current condition. Several years after having been diagnosed with hypertension, he was told he had diabetes and COPD. Upon his recent hypoglycemic episode, he was diagnosed then as having chronic renal failure with congestive heart failure. All of these diagnoses tie well in together, starting with obesity. When a person is obese, the excess weight, especially around the waist and abdomen as seen in Mr.F . causes the workload on the heart to increase due to the excess adipose tissue surrounding the visceral organs and weight in general. Being obese puts one at high risk factors for developing hypertension and heart disease as Mr. F. has. Obesity also places one at high risk for developing diabetes type two due to the fact that adipose tissue and cells that accumulate have a high tendency to become insulin resistant as well as the surrounding cells and tissue; therefore the body can not utilize the glucose and hyperglycemia occurs.A prolonged period of insulin resistance eventually leads to the beta cell failure causing decreased insulin production. The same high fat, cholesterol, and sodium diet that contributed to the patient’s obesity in the first place, causing his heart to have to work harder, more than likely caused him to develop hypertension. The fact of his non-compliance with his medication regimen for hypertension and diabetes, 100 pack per year smoking habit as wel l as noncompliance with prescribed diabetic diet, lead to his further complications of renal failure and lastly CHF.With prolonged hypertension and particularly uncontrolled diabetes mellitus, diabetic nephropathy changes the kidneys in a way that reduces kidney function and eventually, renal failure. Chronic high blood glucose levels cause hypertension in kidney blood vessels and excess kidney perfusion (Ignavicius &Workman, 2006). This increase in pressure within the kidneys cause the blood vessels to leak out that allows large particles such as albumins and proteins to form deposits in the kidneys and their blood supply.This narrows the vessels and decreases oxygenation to surrounding kidney tissue; therefore causing hypoxia and eventually irreversible cell death. As this progresses, scarred tissue forms and the ability to filter urine from the blood ceases causing renal failure. Once in renal failure, the patient’s kidneys were not able to regulate the fluid volume by ade quate excretion, therefore the excess fluid was pooled back into the vascular Integrated Pathophysiology 7 space. This fluid volume overload caused an increased cardiac workload which eventually leads to congestive heart failure.Mr. F. ’s smoking history was the primary cause of his COPD; however it is exacerbated by the collection of fluid in his vascular space due to renal failure, the loss of elasticity of vascular system and congestive heart failure. The medication prescribed for Mr. F. ’s diabetes was Metformin 500 mg daily. This medication primary action was to decrease hepatic glucose production. The excess insulin in the blood triggers production of glucagon in which signals the liver to release stored glucose, in turn hyperglycemia results. This medication was changed due to Mr. F. s elevated BUN and creatinine which is where this medication is metabolized and excreted as well as his state of CHF. Continuing this medication could cause toxicity. The new medica tion he was placed on was a low dose of Actos which is metabolized in the liver and does not cause hypoglycemia as Metformin may. To treat his hypertension, Nifedipine was prescribed and it acts to lower blood pressure by inhibiting calcium transport into myocardial cells and smooth muscle cells within the vascular space resulting in vasodilation counteracting the vasoconstriction caused by hypertension.In addition to Nifedipine, the patient is prescribed an ACE inhibitor named Ramipril. This ACE inhibitor works on the renin-angiotensinogen system ultimately causing systemic vasodilation. This medication not only decreases the blood pressure, it decreases cardiac afterload in patients with CHF. Ramipril is metabolized in the liver, therefore indicated for patients at risk or in renal failure. Furosemide is a loop diuretic that is especially helpful in patients with edema due to hypertension, renal disease as well as CHF.Furosemide increases the renal excretion of water as well as so dium and other electrolytes, thus reduces the fluid volume in the vascular space. It also has a vasodilating effects that are beneficial in this patients regimen; however a potassium supplement must be given due to the potassium wasting caused by this loop diuretic. This patient’s dose of Furosemide was significantly increased due to the necessity of ridding his body of the accumulating fluid and stabilizing his blood pressure which in turn will prevent further damage to his kidney’s. Potassium is necessary for proper contractility of the heart.Mr. F. is on Potassium chloride 10 mEq t. i. d. to make up for the loss due to the loop diuretic effects. The Albuterol inhaler is used to dilate the bronchi thus increasing surface area of the air ways to enable oxygen and CO2 exchange. This inhaler can exacerbate hypertension, palpitations and have a negative cardiac effect as well as cause hyperglycemia; therefore must be used cautiously. Integrated Pathophysiology 8 Predicti on of Outcomes Although Mr. F. ’s acute condition was stabilized, his prognosis appears poor at this point due to his history of noncompliance.Even though he has decreased his cigarette habit to one pack per day, his condition will probably deteriorate unless he could totally abstain from smoking. While speaking with the patient, he assures that this has got his attention and he will remain compliant from here on out. The damage at this point is irreversible; therefore maintaining remaining function as it is now becomes a new priority, meaning that compliance is necessary at this point for this patient as continuing to be noncompliant will definitely lead to his demise.Aggressive diabetic counseling as well as reinforcement of adhering to his current medication regimen is crucial for this patient’s survival. Other disciplines that should be involved to ensure a better prognosis for Mr. F. are ones such as a dietician to help with meal and snack planning per diabetic pr otocol, continuing respiratory therapy to aid in oxygenation and supplies, physical therapy to build the patients strength and prevent venous stasis hence blood clots, and maybe even occupational therapy to assist him with maintaining independent activities of daily living.Routine follow up appointments with his physician as well as specialist for cardiac and pulmonary function are essential to his outcome. A diabetic support group would be ideal for this patient as he appears to be a person in need of a support team. Lifestyles are hard to modify, but when one gets backed into a corner, it can be done, even in the most noncompliant patients otherwise death is imminent. Integrated Pathophysiology 9References Deglin, J. H. & Vallerand, A. H. (2007). Davis’s Drug Guide, Tenth Edition. Philadelphia: F. A. Davis Company. Ignatavicius, D. D. & Workman, M. L. (2006). Medical Surgical Nursing, Critical Thinking for Collaborative Care. St. Louis: Elsevier Saunders. Mosby’s Med ical, Nursing, & Allied Health Dictionary (6th ed. ). St. Louis: Mosby, Inc. Zerwekh, J. , Claborn, J. C. & Gaglione, T. (2006). Mosby’s Pathophysiology Memory Notecards, Visual, Mnemonic, and Memory Aids for Nurses. St. Louis: Mosby, Inc.

Analysis of Mrs Hayward from the Novel Spies by Michael Frayn

How is the character of Mrs Hayward developed throughout the opening 3 chapter of Frayn’s ‘Spies’? Mrs Hayward is a contradictory character who is established through Stephen’s fragmented memory to be both a character of smiling perfection and a broken woman, sitting in the dust weeping. She is both the embodiment of a perfect British wartime wife and a character of suspicion; a spy, a traitor, the epitome of deceit and the focus of two young boys’ overzealous imagination. When the reader is first introduced to this character it is through the listing of three declarative clauses in one of Stephen’s long, complex sentences. It is here that his fragmented memory is emphasised by the fragmented syntax where only glimpses of Mrs Hayward are shared with the reader. She is ‘in the long-lost green summer shade, her brown eyes sparkling, laughing at something Keith has written. ’ Through his use of the verbs ‘sparkling’ and ‘laughing’ Mrs Hayward is portrayed as a friendly and happy character who clearly takes delight from time spent with her child. The use of the adjectives ‘blue’, ‘green’ and ‘long-lost’, help to coat the memory with a sense of vibrancy and suggest that these memories, and characters, are positive, fun and safe; they belong to a lost time that was happy. This is further reflected in the use of pathetic fallacy as the memory, and Mrs Hayward, are in the ‘summer shade’, a time of year and image associated with freedom and enjoyment, suggesting this is a character who is pleasantly remembered and much-liked by the narrator. However, as Mrs Hayward is in the shade this could subtly suggest to the reader that there is an element of darkness to the character as she is shaded, half hidden and perhaps that her motivations and intentions are not always as clear as first imagined. The reflective, gentle tone of Mrs Hayward’s introduction is shattered by the use of the short simple sentence ‘Then the laughter’s gone. ’ indicating to the reader that the memory of her is tainted by events that are still unclear to the reader, events that leave her ‘sitting in the dust in front of [Stephen], weeping’. The antithesis of ‘weeping’ and ‘laughing’ highlight to the reader how Mrs Hayward is a character who evokes feelings of both happiness and shame in Stephen, due to her respective actions and emotions. She is a fragmented and incomplete character who is portrayed to the audience through an anaphoric series of present tense memories, which make her actions, and consequent responses of the narrator, seem immediate and continual. She is a character who evokes an emotional response in our narrator almost sixty years after unknown events have occurred, suggesting to the reader that she is going to be central to his journey down ‘memory lane’. When Mrs Hayward is next introduced to the reader it is through elderly Stephen’s third person account of what would have happened if young Stephen had asked Keith to play at his house for the afternoon. This hypothetical pondering of the narrator occurs after a substantial amount of description has been dedicated to Keith’s home, room and father, suggesting to the reader that these male characters were the main objects of focus for young Stephen, Keith because he idolised his friend and his father because Stephen clearly feared him. Mrs Hayward then appears with her ‘perfectly plucked eyebrow’ while she is ‘reclining on a sofa’ and ‘looking up from her library book’. Frayn has positioned Mrs Hayward in the domestic sphere of the house and then used stative verbs to show her lack of movement and action. This is further highlighted when Keith asks if he can go to Stephen’s house and Stephen knows ‘precisely’ that her response will be to tell Keith to ‘ask Daddy’. Here Mrs Hayward establishes herself as having a typical female role within a traditional patriarchal family. She is contemplative, rested and motherly, she does not make decisions; she is not the dominant person in the relationship and she defers decision-making to her male counterpart – not unlike Stephen in his childhood relationship with Keith. Keith’s mother is referred to in the opening chapters using either the pronoun ‘Mrs Hayward’ or ‘Keith’s mother’, both name link her clearly to the males in her life, showing their dominance as her identity is always linked to them. She is not given her own name or identity and this emphasizes the position that she is in within the family; she is the wife and mother. She is surrounded with the semantic sphere of tranquility and passivity, she is ‘unhurried’, ‘calmly smiling’ ‘reclining’ or ‘looking’ and the only time we ee any use of dynamic verbs is when she is ‘shopping’ or fetching things for Aunt Dee. Mrs Hayward is clearly enclosed within the domestic sphere and has a clear role within her family, even her diary entries revolve around ‘Ted’s parents’, ‘Ted to OH dinner’, ‘K’s term starts’, ‘K’s sports dayâ€⠄¢. Each of these entries foregrounds one of the men in her life and shows their overwhelming importance to her daily routines; this is not unfamiliar of a war-time lady of leisure in Britain but it does highlight how she is trapped and isolated from both the world and society. Mrs Hayward is clearly a character that on the surface is shrouded in an air of tranquility and domesticity. She is the image of perfection and is clearly held in an idiolised position, along with everything associated with Keith, according to Stephen and both his adult and child-like perspective. She is a character who appears rested and calm but underneath this facade there is a secret that she is keeping, it may not be that she is a German Spy like the young boys think but all is clearly not as it seems and Stephen’s ‘perfect’ account of her suggests in itself that maybe she is too good to be true.

The Fifth Replies of Descartes Essay Example | Topics and Well Written Essays - 1000 words

The Fifth Replies of Descartes - Essay Example The Fifth Replies of Descartes The argument in question is the argument of Discourse. The problem with this counter argument is the inherent bias. There is a premise and theres a conclusion if one accepts the premise the conclusion must be accepted. Renà ©e Descartes says that he knows he exists it is inherent that he knows what he is and what his nature is, it is the very definition of establishing his existence. This knowledge (of existing) cannot be separated from the knowledge of what that existence is about. This point can be elaborated through an example for instance one sees a bottle of water. His eyes tell him that it is there. Since this person has the premise that what his eyes see is in fact real (or existing) it means that he knows that the bottle exists. When he say that it exists it means it has certain properties that indicate that it exists. No one can say that something exists without acknowledging the properties. Existence without the knowledge of its properties is even more illogical than deriving a conclusion that existence of self also encompasses the nature of self. When Renà © Descartes say that he thinks therefore he exists, it means that he is aware of what he is and what his nature is. Otherwise there is no existence. Every existence has its properties; be it divine authority like God or as trivial as a plastic water bottle. The objection of Descartes’s claim rests with the understanding of premise. If the critics accept the premise when Renà ©e says that something exists, he also bases this by understanding some properties.

Loke (second treatiseof government, and machiavelli Essay

Loke (second treatiseof government, and machiavelli - Essay Example In a nutshell, emergency involves making preparations before an event. Emergency planning also aims at creating preparedness (Perry 7). It has an influence on response and recovery. Emergency plans guide operational decisions during the management of agent-generated and response-generated demands (Phelan, 2008). On the other hand, emergency operations majorly focus on performance (Phelan 16). Such operations require the use of a set of guidelines presented in terms of a plan. Every decision made during an emergency operation should be based on the guidelines outlined in the plan guide. The success of emergency operations depends on the availability of resources for use and frequent assessment of demands by responders as needs arise. Responders must be alert in order to identify any arising demands and should be creative when addressing such demands. The success of emergency operations also relies on the use of pre-event lists checklists. However, such checklists do not guarantee maxi mum success. Personnel must improvise them in order to achieve higher accomplishments. Actions taken by response personnel and emergency managers are what constitute an emergency operation. 2. Planning Process It is noted with concern that the emergency planning process is more important than the emergency plan itself. Emergency planning ensures that communities achieve disaster preparedness. As a process planning involves consultation, training, equipping, and critiques (Perry 28). The end result of such a process is an improvement in the ability of a community to handle risks. A significant number of individuals think that written plans are used in defining preparedness. I agree with such a line of thinking but the same people should be careful not to equate a plan with preparedness. The process is more important than the plan because it is practical. The plan is only but a picture presentation of the planning process at a specific time and does not guarantee the presence of a haz ard. On the other hand, the process of emergency planning involves practical steps such as ongoing monitoring, personnel training, and system exercising hence providing a definition for preparedness. It is important that organizations and jurisdictions adopt a continuous planning process because preparedness is dynamic in nature. Such a process should include continual monitoring of the environment so as to identify threats and discover new technology that can be used in handling such threats. Resources, threats, and even organizational structure may change over time. Moreover, lack of continuous training may result in the disappearing of performance skills. Such eventualities can only be addressed by ensuring that organization and jurisdictions establish a continuous emergency planning process. Despite the usefulness of the emergency planning process, the process may face some resistance. One main reason for such resistance is apathy. Apathy arises when individuals do not like to t hink about disasters (Phelan 22). Therefore, they develop the idea that emergency planning takes resources hence they end up not supporting the process of emergency planning. 3. Preparedness Exercises Organizations and j

Information Technology Essay Example | Topics and Well Written Essays - 1000 words

Information Technology - Essay Example This report declares the Internet presents a number of gains for senior citizens. It is used as a means of communication via E-mail, chat rooms, debate groups, direct messaging, and so forth. It is found that ninety five percent of seniors who use the Internet do so to remain in touch with associates and relatives. Keeping this significant information regarding the Internet usage of seniors Pill Incorporated will have to advertise about its products Liflex and Forevex on the sites of messaging services. Pill Incorporated has two options whether to paste their advertisement of Liflex and Forevex through a banner on the sites of messaging services providing a hyperlink to the official web site of Pill incorporated. Another way is that Pill incorporated can send their email messages about Liflex and Forevex through using the messenger services databases of seniors residing in United States. This paper stresses that the Internet also provides a wealth of health care information that can be predominantly valuable for the seniors when healthiness turns out to be a larger matter and concern. Seventy five percent of elder Internet users collect health care information on line. The search engines like google, yahoo, and dogpile are main sources to access this information. These companies take some amount of money from online sellers depending upon the competition of online sellers of a product to provide the link of their websites on top when a person uses search engines to get information using a key word related to a product.