Analysis Of The Book Tom Sawyer - 1629 Words

Tom sawyer is a very fun and entertaining book and is great for all families and children alike. Why do i say this, I say this because the book of Tom Sawyer is set in St. Petersburg, St. Petersburg may be small but it s got everything a boy could ever want. This really adds to the excitement and appeal of the book. Another thing that adds to the appeal of the book is the narrator point of view. Twain does a good job of using versatility and verbal skill in the narrator point of view. For example tom s words have a bit of boyish energy to them. For example tom states oh, if only i d had a little more whitewash, this is a lack of a better term, it s as if twain does more than thinking about his characters, it s almost as if he can†¦show more content†¦But tom as smart as he is catches on to aunt polly s motive s and sewed his shirt collar back in place after his swim that afternoon. And tom did so well in fact that Aunt polly apologizes to tom for her suspicions. He almost g ets away with it too. Until sidney Points out that black thread was used to sew back Toms collar which was originally white .This proves that tom can be very intellectual and can make very bad decisions to avoid getting in trouble. Just simple acts like these remind many people of the things they did in their childhood. Which better allows them to connect to the book which is exactly what Mark twain wanted as a writer. To allow people to connect with his novels. Especially his most popular novels like tom sawyer. At times Tom can seem to be unpredictable at times. For example in chapter 3 you see a darker side of Tom. A lot of the time toms carefree attitude mask what could be considered self esteem. He constantly wants something he doesn t quite fully understand something that he considers â€Å"Glory† He is willing to trade many of his worldly possessions for his so called glory. Tom also loves to show off but in darker times when tom feels like he is getting enough love, T om Goes into what i would call a type of depression where he questions whether or not he even deserves to live, by imagining his own funeral. Although tom will never beShow MoreRelatedAnalysis Of The Book Tom Sawyer 1094 Words   |  5 PagesMark Twain’s book titled Tom Sawyer has great popularity. Twain is a famous American author known for his stories. 1876 is the year of publication of the book. Nevertheless, over the years there have been many editions of it. I chose the book because it is quite an interesting read since it presents the adventurous life story of a boy as he grows up. It is thus an adventurous book. His life and the manner in which he interacts with people around him are impressively demonstrated in the book. This paperRead MoreCritical Analysis Of The Adventures Of Tom Sawyer904 Words   |  4 PagesThe Adventures of Tom Sawyer Critical Analysis â€Å"Sometimes problems don’t require a solution to solve them, instead they require maturity to outgrow them.† (1). Eventually in life we will have to grow up and face our problems maturely, and it’s a large price to pay. In The Adventures of Tom Sawyer, Tom faces a challenge of maturity. The question is, did Tom mature socially or morally more? My thesis is Tom matured morally over socially in the book, due to how much he doesn’t learn to obey thoseRead MoreLiterary Analysis Term Paper for Tom Sawyer : a Classic Novel771 Words   |  4 PagesLiterary Analysis Term Paper for Tom Sawyer: A Classic Novel Mark Twain’s book is a novel that follows the juvenile life of a small boy. You will see how much fun the main character, Tom, and his friends have by skipping school, fishing, swimming, and using with their imaginations to have a good time. The Adventures of Tom Sawyer is a classic novel for many reasons. The plot gives us an idea about how people lived in the era the book takes place in. Readers enjoy the book because they can relateRead MoreThe Adventures Of Tom Sawyer . __________________. A Book1061 Words   |  5 PagesTHE ADVENTURES OF TOM SAWYER __________________ A Book Review Presented to Mr. Parsons and Mrs. Amy Lack Woodville High School __________________ U.S. History I and English 10 __________________ by Arian Campbell April 19, 2017 The Adventures Of Tom Sawyer The Adventures Of Tom Sawyer by Mark Twain is a 271-page novel. Tom is a boy, and merely and exactly an ordinary boy on the moral side. What makes him delightful to the reader is that on the imaginative side he is very much more, andRead MoreMark Twain s Adventures Of Tom Sawyer1586 Words   |  7 Pagescharacters, and plot of The Adventures of Tom Sawyer are closely related to Mark Twain’s own life experiences. The fictional town of St. Petersburg very closely resembles Twain’s childhood home in a small town in Missouri, because of the Mississippi River (Stanley 1). He remembers both the ups and downs of his childhood and conveys these in the novel (Higgins). Many of his memories of living by the Mississippi river are displayed in this novel as Tom has several encounters with rivers (â€Å"Mark Twain†)Read MoreAnalysis Of The Adventures Of Huckleberry Finn 1679 Words   |  7 Pages1. Analysis of an Important Character Adventures of Huckleberry Finn is a story about growing up, facing the world, and fighting for what’s right. Huckleberry Finn matures greatly throughout the book, and Tom Sawyer plays an important role in showing this change. His character allows the reader to see Huck’s increase in maturity throughout the story. Tom is the constant, his immaturity not changing from the beginning to the end of Adventures of Huckleberry Finn, while Huck is the changing variableRead MoreHuck Finn Character Analysis Essay1057 Words   |  5 PagesThe Adventures Huckleberry Finn Character Analysis The Adventures of Huckleberry Finn was written by Mark Twain in 1884 and is considered to be a Great American Novel. Mark Twain’s adventurous novel depicts the image of a young American boy living along the Mississippi River in the mid-1800s and expresses interpretations on on rules, morality, and racism. This caused a lot of controversy and criticism, due to the moral compass of the times. Although main characters play a major role throughout theRead More Huck Finn Analysis Essay1322 Words   |  6 PagesHuck Finn Analysis The Adventures of Huckleberry Finn A Critical Analysis SECTION I- Chapters 1 through 11 The book introduces Huck as the first person narrator which is important because it establishes clearly that this book is written from the point of view of a young, less than civilized character. His character emerges as a very literal and logical thinker who only believes what he can see with his own eyes. In this section Huck’s life with the Widow Douglas and her attempts toRead MoreAnalysis Of The Book Adventures Of Huckleberry Finn 1332 Words   |  6 PagesHuckleberry Finn Cheat Sheet Title: Adventures of Huckleberry Finn Author: Mark Twain Publication: December 10, 1884 Setting and Time period: The setting throughout the story mainly takes place along areas by the Mississippi River, and as stated in the book, â€Å"Forty to Fifty Years ago†. Characters: Huckleberry Finn - The protagonist and narrator of the novel. Huck is the thirteen-year-old son of the local drunk of St. Petersburg, Missouri, a town on the Mississippi River. Frequently forced to surviveRead MoreHuck Finn, And The Symbolism Of Huckleberry Finn830 Words   |  4 Pagesinjustice as a way to suggest civilization will never advance unless Americans can overcome the greed they have gained from supremacy. Huck describes many men as great and heroic throughout the novel. The way Huck talks about Col. Grangerford and Tom Sawyer are some of the most evident examples of this. In fact, he dedicates the start of chapter 18 to describe Col. Grangerford as a â€Å"Gentlemen all over† and â€Å"well born.† (105.) But quickly we see Huck’s view is tainted by the Grangerford’s romanticized

Slavery Is A Form Of Forced Labor - 2183 Words

Under the whips, working hard jobs every day and night, a little food, these are realities of slaves live. Have you asked your self can I live in such condition? Definitely the answer would be no even if you were a free. You might have asked what is slavery and when it started? The slavery is defined â€Å"the condition of a person over whom any or all of the powers attaching to the right of ownership are exercised, including where such a condition results from a debt or contract made by the person†. (270.1 Criminal Code)(antislavery.org). Slavery is a form of forced labor has existed since before written records, even playing a large role in biblical time. According to the international magazine, the slavery started 10,000 years ago in â€Å"Mesopotamia† or what it calls now Iraq. Male slaves worked in the field where the female slaves called on for sexual service for their masters. Those slaves were taken after their people defeated in a war. However, the institution of slavery is as old as civilization, and many of empires and nations were built by muscles of slaves From Greek empire to the Roman to the medieval European. In the 17th century even after hundred years, the dehumanize practices of slavery still exist. Slavery in America began when the first African slaves were brought to the North America in 1619 to work in the field and serve (History.com). Some historians estimated that 6 to 7 millions slaves were imported to the new world only in the 18th century. Through theseShow MoreRelatedSlavery Is The Most Extreme Form Of Forced Labor Essay1400 Words   |  6 PagesSlavery Whenever we hear the word â€Å"slavery† in the United States, we tend to think of the Southern part of the United States during the Pre-Civil War era. What many people don’t seem to know, is that this horrible act of slavery has occurred worldwide! The term slavery has many different definitions and has occurred all throughout our world history. It wasn’t until the early 18th century that the thought of anti-slavery came out. Many economic, social, and technological forces have played a partRead MoreThe Slave Of A Slave Essay964 Words   |  4 PagesInternational slave labors In the distant past, people often fought with rival enemies in order to gain resources. The remaining members of the slaughtered tribe were used as slaves. Historical evidences show that slavery was a common practice amongst earliest known civilization. The ancient Greeks, Romans and Egyptians kept certain numbers of slaves. For example, The Greeks preferred having slave women and children for domestic servitude. Similarly, the romans and Egyptians used slave as a meansRead MoreThe Modern Slavery that is Taking Place in our World Today1033 Words   |  4 Pagesâ€Å"Slavery occurs when one person controls another person, using violence or the threat of violence to maintain that control, exploits them economically, pays them nothing and they cannot walk away.† In 1865, slavery was abolished here in the United States. It states in the thirteen amendment that, â€Å"neither slavery, nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdictionRead MoreHuman Trafficking Is Not A Choice1132 Words   |  5 Pagesiii. There are more people involved in slavery today than at the height of the Transatlantic Slave Trade during the 16th, 17th, and 18th centuries. c. Crime against humanity – stripped of their individual freedoms and identities d. Human beings are considered a commodity, and human trafficking is the business. e. Treatment of slaves - no less brutal or degrading today; These individuals are being exploited with the sole intent of being sold to increase one’s economic status; used and reused, abusedRead MoreHuman Trafficking and Slavery880 Words   |  4 PagesHuman Trafficking and Slavery: Are the World’s Nations Doing Enough s to Stamp It Out? Slavery has existed since the beginning of human evolution (CQ Researcher 2010). The Civil War ended slavery in the United States in 1865. Worldwide slavery was prohibited during the late 1920’s. Although slavery is prohibited, millions of victims are forced into captivity. Victims are often kidnapped and forced into a lifetime of servitude and prostitution. Other victims of slavery are lured by the promise ofRead MoreSlavery : A African American Slave1518 Words   |  7 Pageshardships during his life just like any other slave. We look at slavery as a whole picture most of the time and don’t give very much thought to the political, economic, and racial factors that influence slavery, even in modern time. Of course, we know that slavery in the 1800’s was extremely racial in that only blacks were enslaved. However, looking at the statistics as we talk about slavery, it has become widely apparent to me that slavery is largely associated with specific races as well as economicRead MoreHow Slavery Has Changed Today s Modern Society1324 Words   |  6 Pagesdo you define slavery in today’s modern society? The word slavery sparks up heated conversations. The idea that all humans were born with their own rights, no matter what race or class they were in, was not prevalent during the early developmental stages of America. There has always been slaves throughout the history of man, dating all the way back to the 1600’s until today’s day in age when it is no longer legal but still seems to prevail. There are still cases in which slavery still exist butRead MoreSlavery And The United States1690 Words   |  7 Pages Slavery in the United Sates ended in the nineteenth century due to the Emancipation Proclamation issued by President Abraham Lincoln. Sadly, that was only the end of legal slavery. Today a modern form a slavery still continues not only in the United Sates but other countries as well. Some forms of modern slavery are human trafficking, forced marriage, and forced labor. According to Employee Relations Law Journal â€Å"slavery is where ownership is exercised over a person, where individuals are coercedRead MoreHuman Trafficking Is A Problem Within The U.s. Essay1617 Words   |  7 PagesHuman Trafficking Human Trafficking is a problem within the U.S. and Globally. Human trafficking is the trade of humans, most commonly for sexual slavery, forced labor, or commercial sexual exploitation for the trafficker or others. This may involve providing a spouse in the context of forced marriage, or the withdrawal of organs or tissues, including for replacement and ova removal. Human trafficking can occur within a country or trans-nationally. Human trafficking is a crime against the personRead MoreThe Slavery Of Slavery And The Colonization Of America941 Words   |  4 PagesProblem of Slavery Introduction The slavery is a relationship established between two individuals and involves the complete and absolute control of each other. Usually, this domain is established from the force, becoming the slave of an object or possession of the owner, so you end up losing not only their freedom but also their humanity and dignity being. The cases of slavery in the history of humanity are many and are always imbued with very bloody and very violent stories as they pose most absolute

Treating Patient in an Acute Care

Question: Describe a essay about treating patient in an acute care? Answer: Evidence-Based Practice (EBP) is the amalgamation of best available scientific studies and clinicians expertise and patients conscience to provide the best possible outcomes for the patients. These criteria are fundamental components of the holistic nursing process (Kenneth et al., 1998). The present essay discusses the importance of EBP in the nursing approach for acute illnesses with the help of a case study which came across to me while serving in Accident and Emergency (AE) department. I was appointed there to take care of the patients with respiratory problems which also helped me to enhance my knowledge in attending the patients with acute illness and strengthen my experience as a nurse. The present discussion involves the case study of a 19-year old female patient (Wynaden et al., 2005) suffering from Downs syndrome and acute dementia. However, the immediate reason for the admission was acute breathlessness. Patients history sheet revealed that she had undergone surgery for the correction of atrioventricular septum defect. She was also suffering from auditory impairment, vision disturbances and coeliac diseases. On first look, she appeared agitated and found difficulty in communicating with the nursing staff. She was also screaming her lungs out and didnt cooperate with the nursing staff. The available literature helps to correlate the clinical symptoms of the patient with her Down syndrome. Since, breathing is the process of exchanging gases through lungs and regulated by respiratory centres in brain, breathlessness can be correlated with patients of Down syndrome (Raven et al., 2007; Patton et al., 2009). Similarly, Atrioventricular Septal defect is a congenital heart deformity, strongly associated with and commonly found in individuals suffering from Down syndrome (Craig, 2006). Further, visual and auditory impairment and coeliac disease are frequent complaints in patient suffering with Down syndrome (Lott Dierssen, 2010; Shott, 2006; Figueroa et al., 2003). Her inappropriate speech and language characteristics and strange behaviour are also closely associated with Down syndrome (Martin et al., 2009). After admission, the attending nurse started the comprehensive assessment of vitals and ensured the respiration by using Airway, Breathing, Circulation, Disability Exposure (ABCDE) tool. Usually, ABCDE tool is used by physicians to handle emergency cases and it has been found to provide better results by allowing the doctors to concentrate on the most serious life-threatening health disorders (Wardrope Mackenzie, 2004). This approach provides an immediate evaluation and action plan for the health care workers and inspires them to offer efficient treatment along with buying precious time to make decisions on the final diagnosis and treatment plan during emergency cases (Dent Carey 2006). At the beginning of the assessment, the AVPU (Alert Response to Voice, Response to Pain and Unresponsiveness) scale was employed as a part of the review procedure to assess the level of consciousness of the patient. She was alert and responsive as she reacted well to the verbal cues and appropriate ly conveyed that she was in pain (Cormac, 2012). The next phase of protocol involved the evaluation of the respiratory functioning of the patient. The prime goal of this stage is to assess the risk of any life-threatening condition related to respiration. The patient was breathing very fast which was physically identified by the active rise and fall of her chest. Consequently, respiration rate of the patient was 30 breaths per minute (BPM) which indicates tachypnea (Bull, 2011). Abnormal respiration rate can be directly associated with pain, lung disease, pneumonia, anxiety or congestive heart failure (Spicer, 1984; Myers Pueschel, 1991; Bone et al., 1992; Ko et al., 2003; Bloemers et al., 2007). Further, the oxygen saturation level (SpO2) was measured with the pulse oximeter (Marcus et al., 1991), a non-invasive technique used to measure arterial saturation level with the help of a sensor. It measures the percentage of oxygen in the blood and its corresponding haemoglobin (De Villota et al., 1981). Anna's oxygen level was 91 %, which was below the normal range (95 to 100 %) (Marcus et al., 1991). Observation suggests that Anna was suffering from mild hypoxia which implies that there was an insufficient amount of oxygen in the blood. Hypoxia may lead to anxiety, chest infection and lung problems (Marteau et al., 1988; McDowell Craven, 2011). A non-breath face mask was provided to improve her oxygenation (Garcia et al., 2005). Now the nursing team should evaluate the pulse rate which is the second important vital as per the ABCDE protocol. Annas pulse rate was 80 BPM, which is slight faster than the homeostatic level (60 90 BPM). Heart rate faster than normal is suggestive of tachycardia which also implicate rise in blood pressure (BP) (Saenz, 1999). Further, the blood glucose level of Anna was taken as a part of the routine clinical assessment procedures. The blood glucose level was 4.8 mm/L, which falls within the normal range of 3.5 5.5 mm/l. So, the nursing team didnt add any interventions for blood glucose level management (Engelgau et al., 2000; Hill et al., 2011). As per ABCDE protocol, attending nurse opened the windows of the ward room for exposure assessment and treatment. Also, open environment helped to calm her and make her feel relaxed. Anna's body temperature was normal, and the nursing team didnt found any mark of body injuries. Further in the process, the weight of the patient was measured. Annas BMI was 35 which indicate that she is suffering from severe obesity, which can also cause gastrointestinal disorder in patients with Down syndrome. Anna was reported to be suffering from severe constipation which can lead to the development of agitation, rapid pulse, fever, confusion, dehydration and rapid breathing (Cohen, 2003; Holmes, 2014). Constipation as described earlier is not having enough bowel movements (less than three times a week) was also found to be associated with her coeliac disease (Bonamico et al., 2001). As per the National Early Warning Score (NEWS), Anna scored 7 and fell under a high-risk patient category (Hill, 2012). Nurses often employ the SBAR method for the exchange of significant information that calls for instant consideration with the medical practitioners to enhance the patient's safety and well-being (Boutilier, 2007). Primarily, nursing staff tried to deal with the anxiety levels of the patient. Anxiety is a type of feeling of uneasiness caused by any fear (May, 1996), which may originate from the stimulation of the sympathetic nervous system and the hypothalamic pituitary adrenal (HPA) axis. Anxiety may induce complications like an increase in the rate of respiration and cardiovascular excitation (Davis, 1992). As per the ethical guidelines, each patient admitted to the hospital, frequently feels that they are in a safe place and deserve to receive rapid and efficient medical treatment (Armitage et al., 2007). That is why, the nursing staff was trying to assure and console Anna, with the motive of reducing her level of agitation and excitement (Webster, 1999; Jevon et al., 2012). Anxiety is a highly individualised condition which varies in both the physical and psychological response to the inner and external life events (Davis Thaut, 1989). The nursing staff should continuously inform Anna that they are attending to all of her requirements efficiently and without any interruption. It seemed to decrease her anxieties and help her to relax. It is often critical to keep the patients informed at all times since it permits the patient to be part of all the decisions about his or her treatment (Coulter et al., 2008; Vahdat et al., 2014). It is of utmost importance that the nursing team must persuade the nurses to stay calm, composed, gentle, comforting and offering support to the patient in overcoming their anxieties and fears (Brett et al., 2014). The presence of a nurse, their concerns regarding the patients health and other verbal and healing touch methods can assure the patient that they are not by themselves in the current situation. The healing touch technique may be the most constructive and functional nursing intervention available that can effectively decrease a patients anxiety. Accompanying the patient at all times, speak softly and clearly and facing the patient in an attempt to let them read the lips facilitate the better understanding (Hart et al., 2011; Richmond et al., 2012). The active involvement of the health care provider is essential in the nursing field as it facilitates the adherence of patients to the treatment plan resulting in the better outcomes (Armitage et al., 2007). During holistic care, the presence of an attendant is always an added advantage for medical team. In the present case, fortunately, Annas brother was able to present with the appropriate details which helped nurses to manage the condition of the patient. His presence provided a positive sense of protection and helped her to decrease the levels of anger and agitation which consequently improved the breathing. As per the protocol, nurses must exploit simple terminologies to make sure that the patient can understand completely, and nurse/patient dialogue will become meaningful (Bramhall, 2014; Kourkouta Papathanasiou, 2014). Effective communication is the spirit of all human interactions and without which individuals will not be able to communicate with the people around them or share their thoughts or concerns (Vertino, 2014). An effective interaction between the nurses and the patient requires an understanding of the patient and their experiences (McCabe, 2004). Nurses should espouse a body language that is friendly and non-threatening which can help in comforting the patient because it is crucial to have an agreement between the verbal and non-verbal communication in tense situations (Taylor, 1992; Kourkouta Papathanasiou, 2014). Nurses should permit or support the patient's personal expression of pain and discomfort since sometimes it would be helpful in reducing the anxiety by talking or expressing ones feelings (Iezzoni et al., 2006). Anna and similar high-risk patients need a serious attention and effective communication to ensure better outcomes (Morse, 1991). To control Anna's anxiety problem, nurses take up a compassionate stand by providing a socio-psychological support (Laschinger et al., 2005) and increasing the positive self-talk and reducing the negative self-talk in a conversation (Kendall et al., 1989; Ozbay et al., 2007). Doctors and nurses should attempt to build a relationship with the patient who is experiencing generalised anxiety disorder. The conversations with the patient must be carried out in a safe environment to ensure the confidentiality, privacy and dignity of a patient (Fisher et al., 2008). After releasing the anxiety, nursing staff take charge to relieve the respiratory exertion to manage the hypoxia. Anna was encountering breathlessness which usually occurs when the requirement for oxygen surpasses her assumed lung capacity. The increase in the pressure of carbon dioxide in the arterial blood stream activates the respiratory centre in the brain to augments the rate and depth of breathing which ultimately cause dyspnoea. (Wood et al., 1977; Hunter, 2008). As per the National Institute for Health and Clinical Excellence 2007, when a patient admitted to the hospital show an increased rate of respiration of 30 BPM and an oxygen saturation of 92 %, it is treated as an emergency case (NIfHaC, 2007). The nurse must also tend to the breathlessness, which is a premature sign of acute illness (Armitage et al., 2007). To improve the breathing response, the nursing team employed an SBAR tool to raise concern (Pronk, 2008; Tews et al., 2012). Nurses changed the position of the pa tient by adjusting pillows to elevate her head and chest, so as to ensure the comparative easier breathing. The change in position has dual action as it permitted her chest walls to move and expand freely (Harris Crawford, 2008) and enhances oxygen distribution throughout the lungs which ultimately improves breathing in patients (Oksenberg et al., 2006). Evidence suggested that when a person is lying flat, he/she will experience difficulty in breathing. In that case, slight elevation of their head and chest from the surface has been employed to treat breathing difficulties. Furthermore, the individuals with breathing difficulties might be benefitted when they are sitting in a Semi-Fowlers position (30-degree elevation of the upper body) (Yeaw, 1992; Younes, 2003; Chung et al., 2008). So, this is one of the best ways of managing acute breathlessness (Dean, 1985). It is also crucial to know that the upright sitting position permits breathing without the over-bending of the stomach wh ich can confine the diaphragm (Moosavi Booth, 2011). Oxygen saturation below the 92% warrants the administration of oxygen therapy (Kallstrom, 2002). Oxygen therapy involves the use of supplemental oxygen which is frequently delivered directly to the lungs (Creed et al., 2010; Dougherty Lister, 2015). The nurses firstly need to administer 5-10 litres of oxygen by a face mask to attain the saturation of 94-98% (Bradley et al., 2008; Welham et al., 2010). It is a frequent management technique for the patients with acute breathlessness admitted to the hospital (Dougherty Lister, 2015). But, a large quantity of oxygen can cause nose bleed, drying of nasal passages and discomfort to the patients. Therefore, the use of humidified air helps to keep delicate tissues that line the nasal cavity moist. To achieve the required oxygen saturation and saturation range, the physicians must use appropriate equipment and the entire procedure must be recorded (ODriscoll et al., 2008). In the process, Annas oxygenation was done by a non-rebreather oxygen mask. Further, nurses encouraged her to drink cold fluids for recovering the hydration state and mobilize the secretions (Ross Alexander, 2001). The fan was turned on to decrease the body temperature which also helps to calm the patient (Kehl, 2004; Moosavi, Booth, 2011).On the contrary, a cannulation is an alternative option when patients are not able to take sufficient amount of food orally (Cole, 2008). If a patient cannot able to drink then, the nurse would introduce a cannula into her body to administer prescribed fluids. Any change in the vital signs of the patient should be recorded and treated. Nurses also explained all the procedures to Anna, to reduce her anxiety induced breathlessness. Nurses mediate the interactions between Anna and the respiratory physiotherapist who is helping her with breathing exercises. Anna was encouraged to lose weight to control her BMI. Respiratory functions are significantly affected by obesity (Ray et al., 1983). In addition to this, the residual capacity is decreased by the presence of adipose tissue around the chest wall (Salome et al., 2013). Further, nurses administered medications by using a nebuliser. The nebulizer mask vaporizes the liquid medication into fine vapour which is inhaled by the patient. It gives fast relief in patients with acute breathlessness (Hilliard Kenneth, 1996). An electrocardiogram (ECG) assessment of Anna was done to rule out any cardiac-pulmonary involvement. This article has emphasized on the requirement of a complete and efficient assessment plan for working with the patients suffering from acute breathing difficulties. It is of utmost importance to clearly understand the patient's vital signs as these data can influence in making the decision of diagnosis and treatment planning. The collection of the detailed medical history of the patient by nursing staff is an important aspect of diagnosis and designing the treatment protocol for the patient. On concluding remarks, we can say that the collective work of the patients family and the medical team is of foremost importance in making any treatment plan successful. References Armitage, M., Eddleston, J. and Stokes, T., 2007. Recognising and responding to acute illness in adults in hospital: summary of NICE guidance. British Medical Journal, 335(7613), pp. 258-259. Bloemers, B.L., van Furth, A.M., Weijerman, M.E., Gemke, R.J., Broers, C.J., Van den Ende, K., Kimpen, J.L., Strengers, J.L. and Bont, L.J., 2007. Down syndrome: a novel risk factor for respiratory syncytial virus bronchiolitisa prospective birth-cohort study. Pediatrics, 120(4), pp. e1076-e1081. Bonamico, M., Mariani, P., Danesi, H.M., Crisogianni, M., Failla, P., Gemme, G., Quartino, A.R., Giannotti, A., Castro, M., Balli, F. and Lecora, M., 2001. Prevalence and clinical picture of celiac disease in Italian Down syndrome patients: a multicenter study. Journal of Pediatric Gastroenterology Nutrition, 33(2), pp. 139-143. Bone, R.C., Balk, R.A., Cerra, F.B., Dellinger, R.P., Fein, A.M., Knaus, W.A., Schein, R.M. and Sibbald, W.J., 1992. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest Journal, 101(6), pp. 1644-1655. Booth, S., 2013. Science supporting the art of medicine: improving the management of breathlessness. Palliative Medicine, 27(6), pp. 483-485. Boutilier, S., 2007. Leaving critical care: facilitating a smooth transition. Dimensions of Critical Care Nursing, 26(4), pp. 137-142. Bradley, B., Branley, H.M. and Egan, J.J., 2008. Guideline for emergency oxygen use in adult patients. Thorax, 63(5), pp. 1-58. Bramhall, E., 2014. Effective communication skills in nursing practice. Nursing Standard, 29(14), pp. 53-59. Brett, J., Staniszewska, S., Mockford, C., Herronà ¢Ã¢â€š ¬Ã‚ Marx, S., Hughes, J., Tysall, C. and Suleman, R., 2014. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expectations, 17(5), pp. 637-650. Bull, M.J., 2011. Health supervision for children with Down syndrome. Pediatrics, 128(2), pp. 393-406. Chung, S.A., Yuan, H. and Chung, F., 2008. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesthesia Analgesia, 107(5), pp. 1543-1563. Cohen, W.I., 2003. Health care guidelines for individuals with Down Syndrome1999 revision. Down Syndrome, pp. 237. Cole, E., 2008. Cannulation and venepuncture. Blood, 16(10.8), pp. 9-14. Cormac, I., 2012. Essentials of Physical Health in Psychiatry. RCPsych Publications. Coulter, A., Parsons, S. and Askham, J., 2008. Where are the patients in decision-making about their own care. World Health Organization. Craig, B., 2006. Atrioventricular septal defect: from fetus to adult. Heart, 92(12), pp. 1879-1885. Creed, F. and Spiers, C. eds., 2010. Care of the acutely ill adult: an essential guide for nurses. OUP Oxford. Davis, M., 1992. The role of the amygdala in fear and anxiety. Annual Review of Neuroscience, 15(1), pp. 353-375. Davis, W.B. and Thaut, M.H., 1989. The influence of preferred relaxing music on measures of state anxiety, relaxation, and physiological responses. Journal of Music Therapy, 26(4), pp. 168-187. de Rubens Figueroa, J., del Pozzo Magaa, B., Hach, J.L.P., Jimnez, C.C. and Urbina, R.C., 2003. Heart malformations in children with Down syndrome. Revista Espaola de Cardiologa, 56(09), pp. 894-899. De Villota, E.D., Carmona, M.G., Rubio, J.J. and de Andrs, S.R., 1981. Equality of the in vivo and in vitro oxygen-binding capacity of haemoglobin in patients with severe respiratory disease. British Journal of Anaesthesia, 53(12), pp. 1325-1328. Dean, E., 1985. Effect of body position on pulmonary function. Physical Therapy, 65(5), pp. 613-618. Dent, K.M. and Carey, J.C., 2006, August. Breaking difficult news in a newborn setting: Down syndrome as a paradigm. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics, Vol. 142, No. 3, pp. 173-179. Dougherty, L. and Lister, S., 2015. The royal marsden manual of clinical nursing procedures. John Wiley Sons. Engelgau, M.M., Narayan, K.M. and Herman, W.H., 2000. Screening for type 2 diabetes. Diabetes Care, 23(10), pp. 1563-1580. Fisher, C.B. and Oransky, M., 2008. Informed consent to psychotherapy: Protecting the dignity and respecting the autonomy of patients. Journal of Clinical Psychology, 64(5), pp. 576-588. Garcia, J.A., Gardner, D., Vines, D., Shelledy, D., Wettstein, R. and Peters, J., 2005. The oxygen concentrations delivered by different oxygen therapy systems. Chest, 128(4), pp. 389S-389S. Harris, H. and Crawford, A. 2008. COPD. Help your patients breathe easier. RN, 71(1), pp. 21-6. Hart, L.K., Freel, M.I., Haylock, P.J. and Lutgendorf, S.K., 2011. The use of healing touch in integrative oncology. Clinical Journal of Oncology Nursing, 15(5), pp. 519. Hill, K., 2012. National Early Warning Score. Nursing in Critical Care, 17(6), pp. 318-318. Hill, N.R., Oliver, N.S., Choudhary, P., Levy, J.C., Hindmarsh, P. and Matthews, D.R., 2011. Normal reference range for mean tissue glucose and glycemic variability derived from continuous glucose monitoring for subjects without diabetes in different ethnic groups. Diabetes Technology Therapeutics, 13(9), pp. 921-928. Hilliard, K.R., Hilliard and Kenneth R., 1996. Oxygen mask with nebulizer. U.S. Patent 5,586,551. Holmes, G., 2014. Gastrointestinal disorders in Down syndrome. Gastroenterology and Hepatology from Bed to Bench, 7(1), pp. 6. Hunter, J., 2008. Chest drain removal. Nursing Standard, 22(45), pp. 35-38. Iezzoni, L.I., Ramanan, R.A. and Lee, S., 2006. Teaching medical students about communicating with patients with major mental illness. Journal of General Internal Medicine, 21(10), pp. 1112-1115. Jevon, P., Ewens, B. and Pooni, J.S., 2012. Monitoring the critically ill patient. John Wiley Sons. Kallstrom, T.J., 2002. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility--2002 revision update. Respiratory Care, 47(6), pp. 717-720. Kehl, K.A., 2004. Treatment of terminal restlessness: a review of the evidence. Journal of Pain Palliative Care Pharmacotherapy, 18(1), pp. 5-30. Kendall, P.C., Howard, B.L. and Hays, R.C., 1989. Self-referent speech and psychopathology: The balance of positive and negative thinking. Cognitive Therapy and Research, 13(6), pp. 583-598. Kenneth N. Anderson, ed. (1998). Mosbys medical dictionary : illustrated in full color throughout (5th revised ed.). St. Louis: Mosby. ISBN 0815146310. Kevin T. Patton, Gary A. Thibodeau (2009). Anatomy Physiology (7 ed.). Mosby. ISBN 0-323-05532-X. Ko, S., Goldstein, D.H. and VanDenKerkhof, E.G., 2003. Definitions of respiratory depression with intrathecal morphine postoperative analgesia: a review of the literature. Canadian Journal of Anaesthesia, 50(7), pp. 679-688. Kourkouta, L. and Papathanasiou, I.V., 2014. Communication in nursing practice. Materia Socio-medica, 26(1), pp. 65. Gary E. Martin, Jessica Klusek, Bruno Estigarribia and Joanne E. Roberts. 2009. Language Characteristics of Individuals with Down Syndrome. Topics in Lanugage Disorders. 29(2), pp. 112132. Laschinger, H.S., Hall, L.M., Pedersen, C. and Almost, J., 2005. A psychometric analysis of the patient satisfaction with nursing care quality questionnaire: an actionable approach to measuring patient satisfaction. Journal of Nursing Care Quality, 20(3), pp. 220-230. Lott, I.T. and Dierssen, M., 2010. Cognitive deficits and associated neurological complications in individuals with Down's syndrome. The Lancet Neurology, 9(6), pp. 623-633. Marcus, C.L., Keens, T.G., Bautista, D.B., von Pechmann, W.S. and Ward, S.L.D., 1991. Obstructive sleep apnea in children with Down syndrome. Pediatrics, 88(1), pp. 132-139. Marteau, T.M., Kidd, J., Cook, R., Johnston, M., Michie, S., Shaw, R.W. and Slack, J., 1988. Screening for Down's syndrome. British Medical Journal, 297(6661), pp. 1469-1469. May, R., 1996. The meaning of anxiety. WW Norton Company. McCabe, C., 2004. Nursepatient communication: an exploration of patients experiences. Journal of Clinical Nursing, 13(1), pp. 41-49. McDowell, K.M. and Craven, D.I., 2011. Pulmonary complications of Down syndrome during childhood. Journal of Pediatrics, 158(2), pp. 319-325. Moosavi, S.H. and Booth, S., 2011. Pathophysiology of breathlessness. The Cambridge Breathlessness Manual. Morse, J.M., 1991. Negotiating commitment and involvement in the nurse - patient relationship. Journal of Advanced Nursing, 16(4), pp. 455-468. Myers, B.A. and Pueschel, S.M., 1991. Psychiatric disorders in persons with Down syndrome. Journal of Nervous and Mental Disease, 179(10), pp. 609-613. NIfHaC, E., 2007. NICE clinical guideline 50 Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. London: National Institute for Health and Clinical Excellence. ODriscoll, B.R., Howard, L.S. and Davison, A.G., British Thoracic Society (2008) BTS guideline for emergency oxygen use in adult patients. Thorax, 63, pp. 1-73. Oksenberg, A., Silverberg, D., Offenbach, D. and Arons, E., 2006. Positional Therapy for Obstructive Sleep Apnea Patients: A 6-Month Follow-Up Study. The Laryngoscope, 116(11), pp. 1995-2000. Ozbay, F., Johnson, D.C., Dimoulas, E., Morgan, C.A., Charney, D. and Southwick, S., 2007. Social support and resilience to stress. Psychiatry, 4(5), pp. 35-40. Peter R., George J., Kenneth M., Jonathan L., Susan S., 2007. The capture of oxygen: Respiration. Biology (8 ed.). McGraw-Hill Science/Engineering/Math. ISBN 0-07-322739-0. Pronk, N., 2008. Situation-Background-Assessment-Recommendation: A Practitioner's Communication Tool. ACSM's Health Fitness Journal, 12(5), pp. 42-43. Ray, C.S., Sue, D.Y., Bray, G., Hansen, J.E. and Wasserman, K., 1983. Effects of Obesity on Respiratory Function 13. American Review of Respiratory Disease, 128(3), pp. 501-506. Richmond, J.S., Berlin, J.S., Fishkind, A.B., Holloman, G.H., Zeller, S.L., Wilson, M.P., Rifai, M.A. and Ng, A.T., 2012. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. Western Journal of Emergency Medicine, 13(1), pp. 17-25. Robert F. Schmidt, William D. Willis, ed. (2007). Encyclopedia of pain. Berlin: Springer. p. Acute Pain, Subacute Pain and Chronic Pain (Chapter.). ISBN 978-3-540-29805-2. Ross, D.D. and Alexander, C.S., 2001. Management of common symptoms in terminally ill patients: Part II. Constipation, delirium and dyspnea. American Family Physician, 64(6), pp. 1019-1026. Saenz, R.B., 1999. Primary care of infants and young children with Down syndrome. American Family Physician, 59, pp. 381-400. Salome, C.M., King, G.G. and Berend, N., 2013. Effects of Obesity on Lung Function. In Obesity and Lung Disease, pp. 1-20. Humana Press. Shott, S.R., 2006. Down syndrome: common otolaryngologic manifestations. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics, Vol. 142, No. 3, pp. 131-140. Spicer, R.L., 1984. Cardiovascular disease in Down syndrome. Pediatric Clinics of North America, 31(6), pp. 1331-1343. Taylor, M., 1992. The nurse-patient relationship. Senior Nurse, 13(5), pp. 14-18. Tews, M.C., Liu, J.M. and Treat, R., 2012. Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents' Learning of Case Presentation Skills. Journal of Graduate Medical Education, 4(3), pp. 370-373. Vahdat, S., Hamzehgardeshi, L., Hessam, S. and Hamzehgardeshi, Z., 2014. Patient involvement in health care decision making: a review. Iranian Red Crescent Medical Journal, 16(1), e12454. Vertino, K., 2014. Effective Interpersonal Communication: A Practical Guide to Improve Your Life. OJIN: The Online Journal of Issues in Nursing, 19(3), 1. Wardrope, J. and MacKenzie, R., 2008. The system of assessment and care of the primary survey positive patient. Community Emergency Medicine, p.15. Webster, N.R., 1999. Monitoring the critically ill patient. Journal of the Royal College of Surgeons of Edinburgh, 44(6), pp. 386-393. Welham, S.A., O'Driscoll, B.R., Howard, L.S., Davison, A.G. and Edwards, S., 2010. P50BTS Guideline for Emergency Oxygen Use in Adult Patients. Otolaryngology--Head and Neck Surgery, 143(1), pp. 103-104. Wood, S.C., Johansen, K. and Gatz, R.N., 1977. Pulmonary blood flow, ventilation/perfusion ratio, and oxygen transport in a varanid lizard. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 233(3), pp. R89-R93. Wright, J.H. and Davis, D., 1994. The therapeutic relationship in cognitive-behavioral therapy: Patient perceptions and therapist responses. Cognitive Behavioral Practice, 1(1), pp. 25-45. Wynaden, D. and Orb, A., 2005. Impact of patient confidentiality on carers of people who have a mental disorder. International Journal of Mental Health Nnursing, 14(3), pp. 166-171. Yeaw, E.M., 1992. CE Credit: How Position Affects Oxygenation Good Lung down? The American Journal of Nursing, pp. 27-32. Younes, M., 2003. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. American Journal of Respiratory Critical Care Medicine, 168(6), pp. 645-658.

The Picture of Dorian Gray, by Oscar Wilde Essay Example

The Picture of Dorian Gray, by Oscar Wilde Essay On the excerpt analyzed, Basil Hallways paid Dorian visit to see why he had changed so much. Dorian leads Basil upstairs to where the portrait lies. Before murdered, upon seeing the portrait, Basil made a direct reference from the bible by saying your sins be as scarlet, yet I will make them as white as snow also a simile, meaning that he could reverse the damage done on the portrait. After Basil analyzed the portrait and criticized it, Dorian had this epiphany and was overcome with a strong hate awards Basil. With the use words like mad, loathed, hatred, which evoke a negative diction and somber tone, you can foreshadow that Dorian plans to do something not so pleasant with Basil. The theme of sanity versus insanity was displayed when Dorian stabbed Basil repeatedly and kills him. Dorian had become insane and does not know right from wrong. In Oscar Wilds The Picture of Dorian Gray, Dorian is a dynamic character that was influenced to believe that he could do anything and not e punished because of his beauty. After killing Basil, Dorian referred to his body as the thing. The symbolism being that is, Dorian no longer thinks of basil as human being, the imagery was used in the description how basil was killed and help envision the state he was left In, both adding to Doormans characterization. Dorian was driven by the mad passions of an animal, him being an animal himself. When describing how Basil was left leaning over the table with dripping blood, a lot of mommas were used for the reader to pause and draw emphasis on what Is being said. We will write a custom essay sample on The Picture of Dorian Gray, by Oscar Wilde specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on The Picture of Dorian Gray, by Oscar Wilde specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on The Picture of Dorian Gray, by Oscar Wilde specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Dorian Gray has gone Insane and became strongly Influence by Lord Henry. Decision-making became solely based on the outcome of the portrait, and since the portrait would hold the burden of all his sins Dorian feels he has the freedom to do anything he wants. Dorian has become an evil, cruel person with no feelings that switched sanity for Insanity having no conscience control over his actions.