Special Education Teacher Essay Example for Free

Specialized curriculum Teacher Essay Enthusiasm and empathy two words with totally different implications, yet for me, one is the main thrust behind my assurance to educate. It’s been a long and twisting street for me to arrive at this purpose of my life, and for me to find my actual predetermination to be an instructor. It is since I understand that my sympathy for youngsters is the thing that will fortify my training fitness and the mix of my instruction and empathy make me a certified contender for any educating position. To put it plainly, my empathy for youngsters is the thing that drives my energy to instruct. As I consider the street that is in front of me, I am excited with fervor and anxious to investigate the numerous open doors that lay in front of me. A large portion of all, I am enthusiastic about the structure of my future homeroom and destinations I intend to handle in my future profession. I believe I owe my understudies the most ideal childhood and instruction. They merit an invigorating and strong condition that draws out the best in them. I need to urge my understudies to expand their minds and reach for objectives they thought about out of reach. I will endeavor to ingrain ethics in my understudies and urge them to treat one another and their locale with deference and comprehension. My understudies will be my essential obligation their requirements will be set before my own and their improvement will be my need. Before we can know where we are going, we should initially know where we originated from, and the equivalent is valid for the instructive field. While I am making progress toward greatness in my profession, I should instruct myself on the steps my field has made from the beginning of time. Essential exercises can be gained from our nation’s history and the errors made previously. I should consider these past steps the instructive field has made and keep on looking forward. Simultaneously, I will have the option to recognize potential relapses the field is inclining. I realize I can make not just have an effect in the lives of my own understudies, however in the lives of understudies all over the place on the off potential for success that I have firm in my convictions and battle for correspondence and equity everything being equal and request that they be allowed all the chance to accomplish their fantasies. Following current political and monetary issues influencing training will permit me to comprehend the bearing the field is going and make taught conclusions and permit me to hold fast for what I so enthusiastically put stock in, and my contribution in these issues will guarantee the instructive field will keep on advancing. Simultaneously, recognizing and tending to current issues standing up to training will engage me to cause the best possible strides in my journey and further to instruct me. These current issues will disclose to me which gatherings of kids are being disregarded or insulted by our government funded instruction framework and pinpoint which matters I have to battle possibly in support. The significant key is instruction; I should be taught in training. To do this, I will proceed with my training in the wake of getting my bachelor’s certificate. On the off chance that I neglect to do as such, I will be bombing honest youngsters and denying them of their entitlement to quality training. I will likewise go to all educational committee gatherings and be voice for these kids in my locale. I will likewise keep on casting a ballot in state and government decisions with the expectation that I may have any kind of effect concerning these issues thus I can change the lives of youngsters broadly. One of the issues defying training that I am generally energetic about is the measure of government inclusion permitted in our educational systems. Since training is a significant concentration in the nation’s legislative issues and beneficiary of bureaucratic and state financing, the legislature normally implements exacting guidelines and rules on our educational systems. While the level of this government association fluctuates, the most widely recognized deterrent educators are constrained with in such manner is state sanctioned testing. Sincere belief on the issue aside, the truth is that today’s youngsters must have the option to show their insight and comprehension through this kind of evaluation. Chosen authorities have esteemed these subjects and ideas fundamental to the advancement of our country and the evaluation of my understudies will basically turn into the appraisal of my school and above all, myself as an expert. One of my fundamental concentrations in the study hall will be to set up my understudies for these state administered tests, scholastically and intellectually. I will shift my methodologies in training these focal ideas fully expecting arriving at a more noteworthy feeling of comprehension for every one of my understudies with the expectation that they will at that point prevail on such appraisals. While not all will emphatically react to the technique for testing, I should urge them to do their absolute best and endeavor to set them up for this strategy for testing. I will rehearse this technique for evaluation with my understudies preceding the official testing so they may feel great with the strategy for appraisal and feel less worried on test day. Notwithstanding the consequence of the tests, I will figure out what makes a fruitful school year and I will constantly bolster my student’s learning and be pleased with them for the entirety of their effectively colossal achievements. I will give every understudy the degree of help and comprehend they should ensure a general fruitful school year. Besides, to turn out to be progressively experienced and an increasingly educated understudy regarding training, I commit myself to at least thirty hours to taking an interest in K-12 homeroom field understanding. I will join forces with the pioneers in the profession field and dissect their guidance, connections and study hall the board methodologies to pick up knowledge into the field and detract from the experience their prescribed procedures so I might be more ready for my understudies. I will move toward every day with my guide as the excellent open door is it. I will enter the study hall each time with another target I plan to achieve and will love each second I’m ready to spend in the study hall. Few out of every odd vocation empowers their rookies experts the capacity to have prompt hands-on understanding; this open door is genuinely an irregularity and such a gift. This permits me the opportunity to gain from quality perception of senior instructors and collaborations with youngsters in a similar setting I hope to one day educate in. I will likewise have the option to partake in the guidance of these understudies and experience the delight when they handle new ideas and comprehend the essentials. This valuable time will give me a foundation that no study hall can give me and permit me to allude back to these minutes when I have my very own study hall. Notwithstanding examining my guide teacher’s homeroom the executives and connections, I will likewise assess their use of present day innovation in the study hall. All things considered, current innovation has surprised this nation; essentially every calling has been affected by innovation and training is no special case. To be fruitful teacher in the twenty-first century, I should be eager to grasp innovation and investigate choices with respect to how I can fuse innovation into my study hall and exercise plans. My understudies will profit by my utilization of new apparatuses, for example, brilliant sheets or PowerPoint introductions or Webquest online exercise plans I will get ready for them. My principle objective in instructing is making my understudies good and profitable citizenry, and so as to be gainful in today’s age, my understudies should have some mechanical proficiency. While I don’t foresee them word preparing schoolwork assignments, I do hope to investigate progresses in innovation together and I will show them how to utilize these advances for their potential benefit. I should stay exceptional in the most recent turns of events and figure out how I can adequately fuse innovation into my study hall and still stay an understudy centered air. I have to ready to feature my capacity to grasp innovation and my inventiveness and association to possible managers so they might have the option to build up a firm comprehension of my abilities. One keen approach to do only this is to make a site portfolio to exhibit these capacities, alongside my showing theory, experience, development and potential as an instructor. I expect to regard this portfolio as a working resume and will continually keep it current. Nonetheless, to separate my portfolio, beside my phenomenal characteristics and capacities, I intend to entitle a segment of my portfolio explicitly for the guardians of my understudies to follow their child’s exercises, learning and progress in my study hall. I welcome however much parental association in my homeroom as could be expected, thus I am continually considering any extra ways I can permit my folks to be in contact with their youngster and I think an extraordinary segment on my site portfolio is great. Along these lines the guardians can get familiar with me by and by as an individual and instructor so they may feel progressively good with me and my situation as their child’s teacher. My greatest test in this will adjust every one of my desires to turn into a balanced and effective educator. I will never be great and will ceaselessly be figuring out how to better myself for my understudies. I intend to develop and grow the same amount of as my understudies do every year. I boldly acknowledge this demand and trust I am more than skilled to overcome any hindrance that comes my direction. I won't permit anything to possess my understudies from turning out to be fruitful residents or debasing my study hall atmosphere, and I am completely arranged to battle for my students’ fates. It is this sympathy for my understudies and my enthusiasm for their prosperity that makes me an advantage for any school area and a gift to a kid or more each of the, an uncommon instructor.

Typography and Formal Recommendation Report free essay sample

Given data on an innovation or business-related issue introduced for a situation study, assess and incorporate outside research to make an efficient and archived formal logical report or proposition utilizing in any event six sources, including books, articles, interviews with topic specialists, and sites or databases, and set up a lot of introduction slides to go with the proposition. - 8-to 10-page Formal Recommendation Report Topic: Bearings: You may pick any of the subjects underneath for your Course Project†1 The organization that you work for doesn't have a site and isn't exploiting the numerous Internet showcasing openings that are accessible today (the utilization of web-based social networking locales for organizations, pay-per-click publicizing on web crawlers, article promoting, and so forth ). You choose to do some examination about the significance of utilizing the Internet to amplify your company’s presentation and showcasing plan, and afterward compose a proposition to the CEO laying out the advantages and the particular techniques you suggest dependent on your exploration. We will compose a custom exposition test on Typography and Formal Recommendation Report or then again any comparable subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page 2 Write a proposition to your CEO suggesting that your organization actualizes a â€Å"going green† program. This proposition ought to remember the advantages for nature for general and the organization itself regarding corporate picture and citizenship. Give a rundown of techniques and the costs that may be brought about or put something aside for each green idea you suggest executing. Note that there are many green thoughts now, from reusing containers to permitting representatives to telecommute. It’s up to you to choose which works for the association (envisioned or genuine). 3 Your organization is thinking about recruiting a full-time specialized essayist. There is restriction from some administration people who feel that a specialized author isn't needed†¦everyone can compose, correct? It’s your business to examine and compose a proposition delineating the advantages of recruiting an expert to compose archives for your organization, instead of surrendering it over to â€Å"just anybody. † Beyond composing documentation, reports, and recommendations, make a point to cover the assignments that numerous specialized scholars are equipped for too: site the executives, preparing projects, promoting and publicizing, etc. 4 Your organization has as of late extended and the old bookkeeping programming set up is not, at this point equipped for taking care of the jobs needing to be done. It’s your business to examine the different bookkeeping programming programs as of now available (at any rate two) and make a proposal. Variety: Whatever kind of programming your organization may need†¦just make it business-related. For instance, programming for visual depiction, site advancement, content administration, and so on 5 Employee turnover rates are high for some associations, and you have seen that the organization you work for is the same. Research what different associations are doing to recruit and hold great workers so as to battle the high representative turnover rate. Utilize this examination to make proposals to the administration of your association. Crowd: The crowd for this report is an industry leader, for example, your boss or CEO, or an open policymaker, for example, a legislator or official, who could follow up on your suggestions or proposition. You will distinguish this chief in the Course Project subject proposition . Research: Six scholarly as well as expert research sources are required. Your examination must comprise of an assortment of electronic sources (sites, databases, media) and conventional sources (books, diaries, magazines). All sources must be refered to utilizing the American Psychological Association (APA) documentation framework. Last Report/Proposal Details As noted over, the last item will comprise of a 8-to 10-page report or proposition on a specialized or business subject from the affirmed list. The last record incorporates the accompanying. Cover sheet (one page) Cover letter (one page, a couple of passages, single dispersed) Table of substance including rundown of representations (one page) Executive synopsis (one page, a few passages, single separated) Body of report or proposition utilizing the accompanying required areas. Presentation Discussion areas Ends and Recommendations Six research sources gave on APA arranged References page (one page). All references remembered for the Reference page must be refered to in-content. Specialized Illustration or visual, for example, a diagram, chart, or picture that you have made or have found through scholarly research. This ought to be fuse inside the principle body of the report and be referenced in-content. Organizing Elements Single dispersing (or 1. 15), twofold separating among areas and additionally sections 12-point text dimension for fundamental collection of composing Arial, Calibri, Cambria, or Times New Roman textual style type Use of headings and subheadings when proper Section length of around five to seven sentences Standard 1† edges Ragged right defense Multimedia PowerPoint Presentation Details You will introduce your report in a sight and sound specialized preparation †¦eight to 10 slides, incorporating presentation slide with the report title and your name; a few slides for every primary concern of report; an important end slide; utilization of full sentence, significant headings, and short words or expressions inside the body of the slides; at least two important visuals; utilization of a business-suitable structure format; and 5â€7 minutes of portrayal.

8 Critical Cash Flow Rules

8 Critical Cash Flow Rules Did you know…Small businesses in US cite cash flow as one of their top 5 challenges82% of failed small businesses failed due to poor cash flow managementFrom an analysis of 101 failed startups, 29% were found to have failed due to lack of cashFor any entrepreneur, these figures paint a grim picture of the business environment. No-one starts a business with the expectation that it will prematurely dieâ€"though there is always the fear of that possibility.But such stats should not cause you too much worry, just concern.And with the knowledge you’re about to gain, you’ll at least be better off and can make better decisions. The same way big businesses started small and are doing well, so can yours.With good cash flow management being a critical factor in running a successful business, here are some principles to guide you.First, let’s get some basics out of the way.Positive vs Negative Cash FlowCash flow can be either positive or negative. Your business is better off when runnin g with a positive cash flow.Cash flow is positive when the amount of money coming in is more than that leaving the business.Money coming in will be through your receivables while that going out is through your payables. Receivables are mainly sales plus other revenue-generating activities your business is involved in.Payables are all the expenses you incur including external payments to lenders as well as internal ones like salaries.If you realize that your cash flow is negative, it’s time to do some work. Negative cash flow can result in serious business problems.Working Capital vs Cash FlowOne term used almost interchangeably with cash flow is working capital. Although the two are connected, they are very different.Your working capital tells you the overall strength of your business in the long-term. Cash flow on the other hand tells you about the short-term status of your business. Long-term in this case refers to more than 12 months and short-term is less than that.From an acc ounting point of view, working capital is calculated by subtracting your liabilities from your assets. The more your working capital, the more assured you can be of the profitability of your business.But working capital is not all you need to look at. Considering the above-mentioned statistics, cash flow is a major factor to consider.As much as it concerns the short-term, it is that short-term that can adversely affect your business.Money will flow in and out of your business on a daily, weekly or monthly basis.But if this flow is not well balanced and managed, the business might not exist for long enough to achieve your long-term goals.Just think about what could happen if you cannot pay your rent and salaries for four consecutive months.Won’t this affect your business negatively?You might as well be kicked out of the premises you’re running your business from. And that is assuming your employees will be waiting all this while.CASH FLOW RULES FOR A SUCCESSFUL BUSINESSWe would l ike to help you avoid being one of the businesses not succeeding due to cash flow problems.For this reason, we prepared this article to guide you on the things to keep an eye on.These seven rules will give you the ability to handle your cash flow better. With good cash flow management, you’ll have a thriving business.1. Cash is Really KingYou have heard this before. And it’s very true.The abundance of cash in your business provides numerous opportunities. In a similar way, the lack of it spells doom.The number of businesses affected by poor liquidity management are many.The key to understanding the importance of being liquid is to remember that you have periodic payments to make. Such payments are made from cash. And cash is different from sales.Many business owners tend to confuse between revenues and cash. These two are different.Revenues are simply a note of the transactions done. Only when you’re paid for those transactions do you count yourself as having received cash.2. Profits and Cash are Different ThingsFollowing the above point, profit figures can also be misleading to the less experienced business owner.If you’re struggling with these two terms, a simple differentiation is that profits don’t pay bills but cash does.Why?Because profits do not necessarily equal cash.If you take a look at your PL (Profit and Loss) report and decide that you have enough money to run your business, you’ll be wrong.The reason is that profits as per the PL report come from sales made without payments being received.Profits are therefore not the best measure of your financial status as a business. Unless you’re looking at the bigger picture, get a cash flow summary and make decisions based on that.3. Increase in Inventory Means Decrease in CashOne of the things you may be looking for as a business owner is more sales. This is a good thing and certainly worth pursuing.If you sell tangible products and want to have more stock for the expected increase in sales, good.Ask the production team to increase production.Empower your sales and marketing teams and urge them to work towards more revenues. But as you do so, note that it’s going to cost you.The cost may not be direct but it will certainly show in your cash flow summary.As you pump out more goods, either by producing or buying more from suppliers, there is a cost attached.The more inventory you have lying in your store or warehouse, the more your cash flow is stuck.Every product bought or produced costs money. That money has been spent from your cash as an expense. As more cash flows out of the business, will you be having a positive or negative cash flow?As long as expenses are higher than incomes, the situation needs correcting.4. Always Make Cash Flow ProjectionsOne way to stay safe is by making cash flow projections. This is like planning ahead of any activity.And just as planning is essential and helpful in anticipating challenges, so are cash flow projections.Making cash flow pr ojections will help you recognize potential problems before they show up.With the projection, you’ll be having a map of where you want your business to go.If after 1 month you’re not where you expected to be, then you can take a closer look to identify the problem.Without a projection, it’s impossible to do this since you have nothing to use for comparison.In making a projection, you might be tempted to make one and keep it in your mind.This can feel and sound like a quick way of going about it but it’s not the best.It would be best to engage your finance team and other managers to discuss this. If you’re the only employee of the business, then you’ll do it alone. But the important thing is to draft the projection and have physical copies at hand.You can have several in relevant files, even in the cloud for access from anywhere.5. Always Know Your Cash BalanceHow fast can you make a business decision? And how good will that decision be?Good decisions are made when knowle dge is available. Great decisions are made when insights are available. And the best decisions are made when you understand the whole situation.If cash flow problems are big enough to cause businesses to close down, then you should always be on top of things. You may not be the accountant but he reports to you. If you have a big finance department, then the FC might be the one reporting to you.Whichever the case, you need to have some financial data on your fingertips.As the business owner, you’ll be interacting with other business owners or company representatives who are decision makers. If you spotted a good business opportunity, how long would it take you to make a decision?If you’ll need to call your accountant for updates or check the latest report, someone else might get an advantage.The ability to make sound business decisions is determined by how much you understand your business and the factors affecting it.Your should know your cash flow balance. If your business has many daily transactions, you can ask to be updated twice a day. If they are few, maybe twice a week. Whichever schedule you set, just keep those numbers close.6. B2B Business Strains Your Cash FlowIf you run a B2C business, you may not be affected much by this. But if you’re in the B2B business, then keep this in mind.Any time you sell to another business, your cash flow is at stake.This doesn’t mean that you should cease B2B operations. It just means that you should be smart about them.Unlike where you sell directly to consumers and they pay you immediately, selling to other businesses means you wait for the payment.You will deliver or they’ll pick up goods then get an invoice. The invoice will be paid after 30 days, 60 days and in some cases, later than that.This can be a major challenge if you don’t have enough cash to sustain your operations.Whereas there isn’t any automatic solution to this, there are steps you can take to counter this. More on this in the section abo ut managing your cash flow.When making your cash flow projections, take this into consideration. Plan for the potential delays in receiving payments so you don’t expect too much then get disappointed.7. Business Growth Doesn’t Solve Cash Flow ProblemsAs an entrepreneur, you want your business to grow and flourish.And since cash constraints can hamper growth, you may think that growing your business will solve any cash flow problems you might have.Well, that’s wrong. In fact, it may make things worse.How?Business growth requires cash. And if you’re cash-strapped, then growth may not be possible.However, you can get external funding like loans, and that is a better way of going about growth.But if you insist on using cash to expand your business, you’ll end up in big problems.If you have cash flow problems, look for solutions from right within your business.Get the data and take a close look at it. You’ll likely spot issues which when dealt with, will release so much cash into your hands.It all boils down to reducing your periodic expenses while increasing your incomes.TIPS FOR MANAGING YOUR CASH FLOWSince it’s all about having more income and less expenses, what better way of helping you other than giving you some tips to implement?The management of cash flow requires some smart thinking.The good thing about smart thinking is that anyone can learn. This is like many other things in life, e.g communication skills, which can be learned by anyone.Here are 9 tips which will help you manage your cash flow like a pro.1. Monitor Your Cash FlowAlways monitor your cash flow. This is the only way you’ll be able to detect issues early enough. And the sooner you detect them, the easier it will be to solve them.To do this, keep an eye on your periodic expenses and cash inflows. Stay updated on major transactions in your business.You can set the limit for your finance team and ask them to notify you about any payable or receivable above a certain amount, e.g $500.This should be in addition to receiving regular updates, like weekly or monthly, depending on your preferences.2. Get Paid FasterNow here is a trick which may have been played on you without you realizing it.Have you ever been told by a supplier that if you pay on time you’ll pay less? Did you pay on time in order to save some money?No harm if you did. But just know that you fell for a trick. And just to be clear, it’s not a bad trick. It was just a case of someone acting smart. And you’ll also learn how to do the same.Realizing that less money in his pocket now is better than more money in his pocket 2 or 3 months later, the supplier gave you a discount. While you looked for savings and went for the deal, he was looking for faster payment and he got it. Source: The QuickBooks BlogTo encourage your customers, especially your B2B customers to pay you faster, offer them discounts if they pay early.If the invoice terms are 30 days after invoicing, you can offer 10% discount if the payment is made immediately. If it’s done within 3 weeks, the discount can be 7% and 5% if paid in the last week.Any payment done after the due date can attract late fees.Clearly indicate these terms on the invoice itself and don’t use the small fonts typically used for terms and conditions. It should be easy to see the offer since you’re trying to attract attention to them.Communicate the same during contract signing and maybe even mention it when making a sale.3. Pay Less QuicklyAnd just the same way you can encourage others to pay you quickly, you can also seek to pay others less quickly.Before you label this as an unfair tactic, keep in mind that you’ll have to discuss this with your suppliers. They are the ones to either agree or disagree with you r plan.If they give you some extra room in payments, go ahead and take the longest time possible.Since you’ll have it planned for, you shouldn’t get into any problems. And when the situation on your side is good, you can decide to surprise them one day with a prompt payment.The best way to look at this situation is as a negotiation. You’ll be seeking to get the best terms through which to do business with your suppliers. And if they can offer it, why not?Here is a video advising how to negotiate rates even if you already have an agreement.Try it out and see. It works perfectly well. You are looking to free up your money and you should look for ways to make that happen.4. Sell Obsolete AssetsCash flow is about in and outflow of cash, right? And positive cash flow is better than negative cash flow.So what are you doing holding on to assets you no longer use yet they can bring in money?Sell them.If these are machinery or other physical items in your offices, save the space while making some money.If it’s an old vehicle whose maintenance is high, why not sell it and get a new one on credit?Do the math and see what the trade-off looks like.But before concluding that a new one will be more expensive, consider the intangible costs involved.For example, maintaining an old vehicle might be cheaper compared to buying a new one. But what is the impact of using that old vehicle?Are deliveries often delayed due to slow speeds? Maybe due to frequent breakdowns? Or probably there is a lot of inefficiency since it can’t carry many products thus making more trips?5. Use a Cash Flow Tool for ReportingTo see the cash flow status of your business, you require a cash flow summary. This can be provided by your accountant on paper or from the accounting system you’re using.Find out from your team how much of an effort it is to generate the report. If you’re the one handling your finances, then how tasking is it to prepare a cash flow summary?And do you do it correctly? To get things running well and have the confidence that your data is accurate, consider using technology where necessary. Check out a few cash flow reporting tools and pick one if necessary.Remember that you or your team also become more productive when your work gets easier.6. Get External Financing for Big PurchasesWhen you’re about to make a big purchase, do not use cash for it.What if the deal is a real bargain?Even then, keep your cash away from the transaction.Do you remember that one of the things you’ll be doing from now on is trying to get paid faster? How sure are you that the seller isn’t doing the same thing?A rule of thumb regarding cash flow is this: always ensure you have as much cash as possible.So whatever you do, seek to always have as much cash with you as possible. You never know what’s going to happen tomorrow, the next week, month etc.And remember that cash flow problems have the ability to lead to business failure. Learn from those who went through the experience.7. Leasing is Better than BuyingThere has always been a debate on whether to lease equipment or buy them. Which side of the debate are you on?Whereas it’s easy to see buying as the better option, believe it or not, leasing is actually better.Why?Because it’s cheaper.Think about it. Between building an office block and renting a few offices in an already-built building, which is cheaper? Yes, other factors need to be considered, but in many cases, building your own office is more expensive.When you lease equipment, you don’t own it. For that reason, the one who owns it is responsible for seeing it work as expected. That sets you free from the burden of maintenance and supply of necessary accessories.For example, instead of buying a big 3-in-1 printer then maintain it yourself, you can lease one and save on maintenance. The only thing you’ll be doing is   buying printing papers.However, you still have to do your math to see the exact savings you’ll make before le asing.For a printer for instance, check how many toners or cartridges you use per month.If the cost of those toners is higher than the monthly payment you’ll make in the lease contract, then go for it.8. Get Partial Payments for Big OrdersA common situation some manufacturers find themselves in is receiving a big order, starting to work on it, then get paid after delivery.If you’re just starting out in business, you might agree to this arrangement for the sake of signing the deal.But it’s dangerous. Do you remember that payments are rarely made on time?To be safe, ask for some down payment or deposit of some sort. If the whole job costs $4,000, then ask for something like 25% of the full amount before beginning the work.This way, even if there is some delay in payment, you have at least reduced the outstanding amount.9. Have Some Cash ReservesEven after all the planning and monitoring, rarely will everything go as planned.As such, it’s wise to have some cash reserved for eme rgency cases. You can decide to make this amount a percentage, say 200% of your payables. This covers you for two months in case things get thick.To be successful with this, you will do well to be clear what “emergency” means.It should not be easy to get money from this account as that will not serve the intended purpose.This money should only be used when nothing else can be done. It should be the very last option you have.For example, you could decide that the money will only be used when your suppliers have threatened you with a lawsuit. Or when you’re almost about to be kicked out of your business premises.Whatever situation you decide to use as a definition of your business emergency, just make sure it reflects the purpose.CONCLUSIONCash flow problems are real but can be avoided with proper planning.Get to know your expenses, make projections and put a cash reserve in place.This will help you mitigate any cash flow threats.

The Gathering Place A Refuge For Rebuilding Lives

Trademark Trouble Since the creation of an LLC requires the members to, pre  §7-80-203 of the Colorado Revised Statutes, which states, â€Å" One or more persons may form a limited liability company by delivering articles of organization to the secretary of state for filing† (Col. Rev. Stat. 2013,  §7-80-203). Due to this requirement, I researched Mrs. Jackson’s possible trademark name of ‘The Gathering Place†. With in the Colorado Secretary of State Office business name, trademark, and trade name records database, I found a number of records for businesses named ‘The Gathering Place’. Both ‘The Gathering Place: A Refuge for Rebuilding Lives’ (Col. Sec. Stat. 20131400199, 2013) and the ‘The Gathering Place Church’ (Col. Sec. Stat. 20131131269, 2013) hold effective - currently valid - trademarks and trade names to the phrase ‘The Gathering Place’ with an extension to the phrase such as ‘churchà ¢â‚¬â„¢ or ‘a refuge for rebuilding lives’. Although, the formerly listed companies’ phrases maybe distinct enough from Mrs. Jackson to use the phrase ‘The Gathering Place’, the Good Standing status of a company with the name ‘The Gathering Place Inc.’ (Col. Sec. Stat. 20141495695, 2014) would not allow Mrs. Jackson to use the phrase as the name of her business. Based on this finding she will not be able to use ‘The Gathering Place’ for her business. And even if she was able to obtain use of the name, the numerous businesses associated with differing adaptations of the phrase in conjunctionShow MoreRelatedDomestic Violence Case Study1235 Words   |  5 Pageschildren by confronting the attitudes, behaviors and systems that perpetuate it, and by providing victims with the services necessary to rebuild their lives safely and free of fear. 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Realizing this requires various management strategies, such as a thorough store open planning, an assortment of merchandise that suits the particular needs of the community, and the proper education and treatment of employees. Seven-Eleven Japan has put in a place a system for continuous, multi-faceted support of franchiseeRead MoreBp Sustainability Essay28986 Words   |  116 Pagesprospects as a company and to society as a whole. This report should, therefore, start with a clear acknowledgement – 2010 was a year that called BP’s sustainability into question. The tragic accident in the Gulf of Mexico on 20 April 2010 cost 11 lives, leading to a major oil spill and a widespread loss of trust in BP. We are so very sorry for what happened. Nothing can replace the people who died and our thoughts remain with their loved ones. Our task now is to earn back the trust that was lostRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 Pagesby century’s end. But for a clear majority of these migrants, movement was coerced by flight from war and oppression or was enticed by labor recruiters who preyed on the desperately poor. The prospects for the great majority were almost invariably lives of drudge labor in urban sweatshops, on tropical plantations, or on the wharves of an expansive, global export economy. Throughout the century, advances in human rights, which were spread ever more broadly among different social groups—includingRead MoreDeveloping Management Skills404131 Words   |  1617 Pagesdo not learn much just by sitting in a class listening to teachers, memorizing pre-packaged assignments, and spilling out answers. They must talk about what they are learning, write about it, relate it to past experiences, apply it to their daily lives. They must make what they learn part of themselves.† (Chickering Gamson, 1987) In their classic book on active learning, Bonwell and Elson (1991) list seven defining characteristics. 1. Students are involved in more than passive listening. 2. StudentsRead MoreMarketing Mistakes and Successes175322 Words   |  702 Pagesvery rich. But this was to cause some serious concerns for the firm. Brain Drain Craig Silverstein, a fellow Stanford Ph.D student, was the first hire of Page and Brin. He helped them move their equipment out of Page’s dorm room and into a place with more space and, more importantly, a garage. In early 1999, five months later, the enterprise had grown enough to move into offices on University Avenue in downtown Palo Alto. The firm’s fortunes continued to improve, and Craig became director

Homeless Veterans The Fight at Home - 1367 Words

Homeless Veterans: The Fight at Home Every night more than sixty-five thousand veterans are looking for a place to lay their heads, they are homeless. For over a decade these men and women of our armed forces have been returning home from the conflicts overseas; each year their presence in the homeless community has increased significantly. The reintegration from a structured military lifestyle to a lax civilian life can make adjusting difficult for service members. These men and women, who have fought for our way of life, return to the States to find themselves fighting for a place to call home. The number of homeless veterans increases every year due to the financial strains, engagement in risky behaviors and mental health disorders that soldiers are faced with while trying to reintegrate in to civilian life. After serving in the military for a number of years with a guaranteed paycheck, some soldiers have a harder time remaining financially stable when transitioning into the civil ian world. Often soldiers will leave the military without the appropriate funds set up, such as a savings account with enough money to cover expenses while moving or looking for another place of employment. They are often unable to set up a budget to prevent over spending and heading farther in to debt. While in the military, service members are more likely to resort to using payday advances, which takes away from future earnings and has high interest rates; resulting in a cycle of loans andShow MoreRelatedThe Problem Of Being Homeless1006 Words   |  5 PagesThere is not one person who is exactly alike. As people grow up and start to learn who they are they start to make their own choices. 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The veteran homelessness problem is the most ominous type of chronic homelessness, but a solution is possible. Veteran homelessness is a chronic problem in America today, and it is due to the mental state of veterans and government’s failed responses toRead MoreHomeless War Veterans Essay703 Words   |  3 PagesSpeech 301: Public Speaking Problem Solution Speech Homeless Veteran’s INTRODUCTION: How many people have a Veteran in their family or know one? If yes do you help them or is it someone else’s problem. Well many people think it’s someone else problem, but the truth is it’s our problem. They gave there all for each of us! PROBLEM: Veterans being let go from service without appropriate long tern help. Leaves unthinkable large numbers of Veterans helpless without knowledge on how to fit back in toRead MoreVeterans Of The Us Military861 Words   |  4 Pages Veterans of the US military should be some of the most respected men and women of the United States. They risk their lives for years to fight for the freedom of Americans, and yet when they return home some are left homeless, financially unstable, injured, or worse. These men and women need help and should no longer be left to fight on their own. Veterans should be provided with a center to get back on their feet because many veterans suffer from mental disorders and substance abuse due to the thingsRead MoreThe Problem Of Homeless People1280 Words   |  6 PagesWhen thinking of homeless people, one would probably think of a bum who is an addict or alcoholic. Homelessness affects a variety of people. Homelessness as an issue in today s society is largely ignored. The problem of homelessness is barely noticed. The growing population of homeless people is shown that more people are still suffering financial problems and struggling in maintaining their life basis. Many families and children have experienced trauma prior to becoming homeless. 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Why is this happening, and how can we help to reduce the amount of disabled homeless veterans in our society? We live in a free country, a country t hat allows others to fight for our freedom, yetRead MoreThe Disgrace of Veteran Homelessness Essay1400 Words   |  6 Pagesfalls prey to a social ill that plagues every society, that of the homelessness of its citizens. Shamefully of those homeless 23% are reported to be veterans, although the actual numbers may be much larger (Coalition for the Homeless). These soldiers gave of themselves for their country and now annually more than 500,000 of them experience homelessness (National Coalition for the Homeless). It is a disgraceful fact that in the greatest country in the world, the men and women who once represented America

My Professional Goals Free Essays

My long term professional goal is to be a Pediatrics Nurse Practitioner. Being a caring person especially to the children is a part of my personality. I have always loved children and it burdens me whenever I see children sick. We will write a custom essay sample on My Professional Goals or any similar topic only for you Order Now Sympathizing will not do any good, I have an urge to do something to cure, prevent and ease their ailments so I concluded that being a Nurse would be the best choice. Every time my children got sick I wish that I could respond not just as a parent who support but a parent who cares. An event that really encouraged me to pursue becoming a Pediatrics Nurse Practitioner is when my two-year old daughter got a second degree burn. She was admitted at the Children’s Hospital in Seattle, WA. I saw the nurses taking care of my daughter more than I could. I am neither intimidated nor jealous of the nurse looking after my daughter. What I felt was guilt. I know that I have the passion for taking care of children. I know that I am capable of being a good nurse. After that event, I made up my mind to I will be a Pediatric Nurse. I am pursuing the nursing field so that I can graduate as a Registered Nurse with Bachelors of Science degree. I will work as a staff nurse, but after about a year I want to choose my specialty as a pediatrics nurse. I am also aiming to apply in a graduate school to achieve my ARNP license and to get my masters degree in Nursing with the specialty of pediatrics. Then I plan to work as a Pediatrics Nurse Practitioner for a hospital or clinic. I have a desire to go in rural areas in able to help more children because medical treatments are limited in such areas. I am hoping to be accepted to the nursing school so that I can achieve my first goal towards success. How to cite My Professional Goals, Essay examples

Female Entrepreneurship

Question: "Why the world needs women entrepreneurs"- Investing in businesswomen will boost the economy for everyone, says Tory Burch, chief executive and designer, Tory Burch. Analyse this statement. Answer: Women entrepreneurs contribute to the self development, family, community and to the society, as a whole. It is very important to look for ways by which women entrepreneurship can be promoted further so that the number of men entrepreneurs and women entrepreneurs can be equal to that each. There are plenty of countries wherein women arent allowed to work or be an entrepreneur or compete with men in the open world. There are few countries in the world that motivate and help their women to be an entrepreneur and on the other end, there are many countries which dont allow their women to see the world of entrepreneurship. Men entrepreneurs can understand the expectations of men in the society and hence, the needs of the women are felt unnoticed. When women get into entrepreneurship, they will understand the requirements of the women and hence, a product which has been never developed before comes into picture. It is the responsibility of the men in the family to motivate their mother, sister, wife or daughter to set up a business so that they can do something for the economy of the country. This motivation is lacking in the lives of the many. Women have a different perception towards different things and hence, they will come up with a different solution to the same problem. It is not comparison between men and women but it is just that they come up with different and new unique ideas which wouldnt have been thought otherwise. Women have household responsibilities as well and hence, maintain a balance between work and household activities is a task for the women. Due to this, the women in the society avoid taking up other responsibilities than that of the regular household work (Noguera 2013). Access to capital for women is comparatively less than that of capital accessibility for men. There are plenty of small financial institutions which will help women to set up a business but the potential entrepreneurs arent aware of the availability of the funds. The financial institutions should look for ways by which their funds can be increased so that they can help more women entrepreneurs and at the same time, the availability of funds should be advertised so that it can reach the right people. The number of advisers who can help women entrepreneurs are very less. There can be motivational speech so that the women can understand the different aspects of business. These meetings can be held regularly so that the women entrepreneurs can get their queries sorted and at the same time, they can be motivated to grow. Lastly, women need to be educated so that they can be good entrepreneurs. They will get an idea on what are the various things that can be undertaken so that they are aware of the facilities that are available and the facilities that they will have to struggle for. The gender gap should also be reduced so that the women entrepreneurs in the society are given an opportunity to explore and help the society (Brush 2012). References Brush, C, 2012, Introduction:femaleentrepreneurshipand economic development: an international perspective, Entrepreneurship and regional development, vol. 24, no. 2, pp. 1-6 Noguera, M, 2013, Socio-cultural factors andfemaleentrepreneurship, International entrepreneurship and management journal, Vol. 22, no. 3, pp. 294-312

Principles of Management Multi Organ Failure Essay Example

Principles of Management : Multi Organ Failure Essay * Day 6 – 7 /ABC * ABC Principles of Management : Multi Organ Failure /MODS * PRINCIPLES OF MANAGEMENT : ABC / Multi Organ Failure (MODS) * Multiorgan dysfunction syndrome (MODS) is the progressive dysfunction of more than one organ in patients that are critically ill or injured. * It is the leading cause of death in intensive care units (ICUs). * The initial insult that stimulates MODS may result from a variety of causes including, but not limited to, extensive burns, trauma, cardiorespiratory failure, multiple blood transfusions, and most commonly, systemic infection. Schumaker, 2006) * The term MODS has been referred to interchangeably as systemic inflammatory response syndrome (SIRS) and multisystem organ failure (MSOF). (Schumaker, 2006) * A. Determination and Management Multi Organ Failure: Etiology and Risk Factors * Causes of MODS include: * dead tissue * injured tissue * infection * perfusion deficits * persistent sources of inflammation such as pancreatitis or pneumo nitis * High Risk for developing MODS : * Impaired immune responses such as older adults clients with chronic illnesses * clients with malnutrition * and clients with cancer * Clients with prolonged or exaggerated inflammatory responses are at risk, including victims of severe trauma and clients with sepsis * Multi Organ Failure: Classification * 1. Primary MODS – * results directly from a well-defined insult in which organ dysfunction occurs early and is directly attributed to the insult itself. â€Å" * The direct insult initially causes a localized inflammatory response that may or may not progress to SIRS. An example of primary MODS is a primary pulmonary injury, such as aspiration. * Only a small percentage of clients develop primary MODS. * Multi Organ Failure: Classification * 2. Secondary MODS * is a consequence of widespread systemic inflammation, which develops after a variety of insults, and results in dysfunction of organs not involved in the initial insult. * Th e client enters a hypermetabolic, state that lasts for 14 to 21 days.. * During this body engages in autocatabolism : which causes changes in the bodys metabolic processes. rocess can be stopped,. the outcome for the death. * Secondary MODS occurs with condition septic shock and ARDS. (Black,2005 , p2474) * Multi Organ Failure: Clinical Manifestations * There is usually a precipitating event to MOD: * aspiration, * ruptured aneurysm * Septic shock which is associated with resultant hypotension. * The client is resuscitated; the cause is treated; and appears to do well for a few days. * The following possible sequence of events often develops. * Multi Organ Failure: Clinical Manifestations The client experiences SIRS before MODS Within a few days * there is an insidious onset grade fever, tachycardia, increased numbers and segmented neutrophils on the different count (called a left shift), * dyspnea with the diffuse patchy infiltrates on the chest x-ray client * often has some deteri oration in mental reasonably normal renal and hepatic laboratory results * Multi Organ Failure: Clinical Manifestations * Dyspnea progresses, and intubation and mechanical ventilation are required. * Some evidence of agulopathy (DIC) is usually present. * The client is usually stable hemodynamically and has relative polyuria, n increased in cardiac index (greater than 4. 5 l/min), * Systemic vascular resistance of less 600 dynes cm-5 Clients often have increased blood glucose level in the absence of diabetes * Multi Organ Failure: Clinical Manifestations * Between 7 and 10 days: * Bilirubin level increases and continues to increase, followed serum creatinine. * Blood glucose and lactate level continue to increase because of the hypermetabolic state. * Other progressive changes include nitrogen and protein combined with decrease level of serum albumin, pre-albumin, and retinol binding protein * Multi Organ Failure: Clinical Manifestations Between 7 and 10 days * Bacteremia with enter ic organism is common and infection from candida viruses such as herpes and cytomegalovirus are common. * Surgical wound fail to heal, and pressure ulcer may develop. * During this time, the client needs increasing amounts of fluids and inotropic medications to keep blood volume and cardiac preload near normal and to replace fluid lost through polyuria * Multi Organ Failure: Clinical Manifestations * Between day 14 and day 21: * The client is unstable appears close to death. * The client may lose consciousness Renal failure worsens to the point needs dialysis. * Edema may he present because of low serum protein levels. * Mixed venous oxygen level may increase because of problems with tissue uptake of oxygen caused by mitochondrial dysfunction. * Lactic acidosis worsens, liver enzymes continue to increase, and coagulation disorders become impossible to correct. * Multi Organ Failure: Prognosis * If the process of MODS is not reversed by day 21, it is usually evident that the client w ill die. * Death usually occurs between days 21 and 28 after the injury or precipitating event. Not all clients with MODS die; however, MODS remains the leading cause of death in the intensive care unit with mortality rates from 50% to 90% despite the development of better antibiotics, better resuscitation, and more sophisticated means of organ support. * Multi Organ Failure: Prognosis * For those clients who survive, the average duration of intensive care unit stay is about 21 days. * The rehabilitation, which is directed at recovery of muscle mass and neuromuscular function, lasts about 10 months. * Multi Organ Failure: Medical Management * Restrain the Activators: Manifestations of potential infection must be quickly treated to restrain the activators of MODS. * If the agent is known, antibiotics to which the organism is sensitive should be administered. * If the organism is not -known, broad-spectrum antibiotics are given * If the severity of the sepsis is identified early and d rotrecogin alfa (Xigris) is ad ministered, progression to MODS may be prevented * Multi Organ Failure: Medical Management * If there is progression, the lungs are often the first organs to fail and so require special attention. Aggressive pulmonary care is needed in all clients who are at risk of MODS. * Interventions may be as simple as coughing and deep breathing or ambulation. * The clients oxygen saturation should be monitored as well. * Malnutrition develops from the hypermetabolism and the GI tract often seeds other areas with bacteria, some clinicians require the client to be fed enterally. * They believe that feeding enhances perfusion and decreases the bacterial load and the effects of endotoxins * Multi Organ Failure: Nursing Management Care of the client with MODS is multifaceted, balancing the needs of one system against the needs of another while trying to maintain optimal functioning of each system * Nursing diagnoses appropriate for the client with MODS * The number of independent nursing interventions for the client with MODS is limited. * Multi Organ Failure: Nursing Management * The overall goal for nursing is effective client and family coping: * Nurses must remain sensitive to the needs of the family. Caring for the family of critically ill clients is a challenge in that understanding, predicting, and intervening with families in crisis is less exact, than the calculation of oxygen needs. * There are no easy formulas to use to provide hope, courage, coping, and caring. * Nurses must remain alert to the needs of the family as well as the client during this stressful time. * B. Life saving and Intervention * Detailed discussion and return demo will be discussed on EDN and Vines laboratory. * 1. First Aid Measure * 2. Basic Life Support * 3. Advance Cardiac Life support * First aid measures Is an immediate care given to a person who have been injured or suddenly taken ill. * It includes self help and home care when medical assistance is delayed or not available. * Roles of First Aid: * Bridge that fills the gap between the victim and the physician. * It is not intended to compete with nor take the place of the services of the Physician. * It ends when medical assistan ce begins. * Basic Life Support ( BLS) * An emergency procedure that consists of recognizing respiratory arrest and cardiac arrest or both and the proper application of CPR to maintain life or until a victim recovers or advanced life support is available. C-A-B steps : * Circulation restored * Airway opened * Breathing restored * ADVANCE CARDIAC LIFE SUPPORT (ACLS) * Refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions. [1] * ADVANCE CARDIAC LIFE SUPPORT (ACLS) * Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Only qualified health care providers * (e. g. hysicians, paramedics, nurses, respiratory therapists, clinical pharmacists, physician assistants, nurse practitioners * and other specially trained health care providers) can provide ACLS, as it requires the ability to manage the patie nts airway, initiate IV access, read and interpret electrocardiograms, and understand emergency pharmacology. * Fluid Resuscitation (Study) * The infusion of isotonic IV fluids to a hypotensive Pt with trauma; aggressive FR may disrupt thrombi, ^ bleeding, and v  survival * Intravenous literature: Boyd, J. H. , Forbes, J. , Nakada, T. A. , Walley, K. We will write a custom essay sample on Principles of Management : Multi Organ Failure specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Principles of Management : Multi Organ Failure specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Principles of Management : Multi Organ Failure specifically for you FOR ONLY $16.38 $13.9/page Hire Writer R. and Russell, J. A. (2010) * Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality. Critical Care Medicine. 2010 Oct 21 * FLUID RESCUCITATION * Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or pathologic processes. * Fluids can be replaced via oral administration (drinking), intravenous administration, rectally, or hypodermoclysis, the direct injection of fluid into the subcutaneous tissue. Fluids administered by the oral and hypodermic routes are absorbed more slowly than those given intravenously. * FLUID RESCUCITATION * Procedure * It is important to achieve a fluid status that is good enough to avoid oliguria (low urine production). * Oliguria has various limits, a urine output of 0. 5mL/kg/hr In adults is adequate and suggests adequate organ perfusion. * The parkland formula is not perfect and fluid t herapy will need to be titrated to hemodynamic values and urine output. * The speed of Fluid Replacement may differ between procedures. * The planning of fluid eplacement for burn victims is based on the Parkland formula (4mL Lactated Ringers/kg/% TBSA burned). * The parkland formula gives the minimum amount to be given in 24 hours. * Half of the value is given over the first eight hours after the time of the burn (not from time of admission to ED) and the other half over the next 16 hours. * In dehydration, 2/3 of the deficit may be given in 4 hours, and the rest during approx. 20 hours * FLUID RESCUCITATION The initial volume expansion period is called the fluid challenge, and may be distinguished from succeeding maintenance administration of fluids. During the fluid challenge, large amounts of fluids may be administered over a short period of time under close monitoring to evaluate the patient’s response. * Fluid challenge, as the procedure of giving large amounts of fluid in a short time, may be reserved for hemodynamically unstable patients, distinguished from conventional fluid administration for patients who are not acutely ill, who receive fluids as part of a diagnostic study, or for less acutely ill patients in whom fluid administration can be guided by fluid intake and output recordings. VARIOUS FLUIDS USED IN FLUID RESCUSITATION * Crystalloids are solutions of mineral salts or other water-soluble molecules. * we are talking about salt (saline) ; Since isotonic fluids have the same concentration as the normal cells of the body and blood, when infused intravenously, they will remain in the intravascular space. * Normal saline (0. 9% NaCl) and lactated Ringers solution are typical isotonic fluids with sugar in (dextr ose) * Hypertonic fluids –( 3% NaCl) have a higher particle concentration than in normal cells of the body and the blood. These agents draw fluid into the intravascular space from cells. * Hypertonic saline (3% NaCl) is a common hypertonic fluid. * Hypotonic fluids * (0. 45 normal saline, 0. 33 NaCl) are composed mostly of free water and will enter the cells rather than remain in the intravascular space. * Normal saline and lactated Ringers are the two balanced salt solutions most commonly used in current fluid resuscitation * Other products * Albumin, * one of the original plasma expanders, is a protein that maintains osmotic pressure in a cell and helps the cell maintain its internal fluid. When we read about protein in urine, especially in diabetics and those with kidney disease, we are talking about albumin. * Blood transfusion is the only approved fluid replacement capable of carrying oxygen * C. Life Maintaining Intervention * C. 1 AIRWAY MANAGEMENT By: Angkana Lurngnat eetape, MD. * Indication for tracheal intubation * ? Airway protection * ? Maintenance of patent airway * ? Pulmonary toilet * ? Application of positive pressure * ? Maintenance of adequate oxygenation * Oral endotracheal tube size guideline During Laryngoscopy ; Intubation * ? Malposition * – Esophageal Intubation * – Bronchial Intubation * ? Trauma * – Tooth damage * – Lip, tongue, mucosal laceration * – Dislocated mandible * – Retropharyngeal dissection * – Cervical spine * ? Aspiration * C. 2 Managing Patients on Ventilators Clinical Nursing Skills * By Sandra F. Smith * Managing Patients on Ventilators * Preparation: * Double check the ventilator settings against those ordered by the physician. * Plug the machine and turn it on. * Familiarize yourself with location of alarm system Connect the ventilator tubing to patient’s endotracheal tube or traheostomy tube * Procedure: * Monitor pt VS every 5 minutes until stable * Obt ain ABG 15 minutes after ventilation is established. * Monitor ventilation setting. * Check humidifier fluid level. * Records I and O and daily weight Positive pressure may cause positive water balance due to humidification of inspired air. * C. 3 Managing Patients on Ventilators * Suspend ventilator tubing from an IV hook or support it on a pillow to reduce traction on the endotrachael tube. Change ventilator tubing every 24 hours. * Check VS and auscultate lungs every hour. Rationale: Positive pressure ventilation may decrease venous return and cardiac output. * Observe and listen for possible cuff leaks around TT or ET. * Empty accumulated water on ventilator tubing. Disconnect tubing and stretch it to release water trapped into corrugated areas and drained to water basin DO NOT drain water back to humidifier. * Provide patient a method of communication. , such as magic slate. * Test nasogastric drainage pH every hour and administer antacid to maintain pH above 5. Test nasogastri c drainage and fecal matter daily for occult blood. * Assess lungs compliance * Implement methods of stress reduction. * Keep ventilators alarms on * C7 Fluid and electrolyte problems By Canthera Cancer Therapy Center * Fluid and electrolyte problems 1. Water retention * Water retention is simply the buildup of excess fluid in tissues. * Swelling of the feet, ankles and hands are generally the first sign of water retention. * But it can also affect other parts of the body such as the abdomen, chest cavity, face and neck. Possible causes include: * Certain medications (some chemotherapy drugs can cause water retention) * Heart, liver or kidney disease * Blockage of veins or lymph system * Fluid and electrolyte problems * Some symptoms to look for and report to your physician include: * Feelings of tightness in the arms or legs. * Difficulty fitting into clothing. * Rings, wristwatch or shoes fit tighter than usual. * Pitting of the lower legs and arms – when you press on your skin with your finger is there an indentation that remains for a few seconds. * A sense of heaviness or weakness in the arms or legs. Skin that feels stiff or taut. * Any redness, changes in skin temperature or pain in swollen areas can be a sign of infection and should be reported immediately. * Fluid and electrolyte problems * Things that you can do to help manage swelling are: * Do not stand for long periods of time. * When sitting or lying keep feet/legs elevated as much as possible. * Avoid tight clothing (including s ocks) * Do not cross your legs when sitting or lying. * Try to reduce your salt intake. Avoid foods that are high in salt content such as chips, tomato juice, cured meats, and canned soups. Weight yourself daily – a weight gain of 5 pounds or more in one week should be reported to the physician immediately. * If your physician has prescribed medications for your swelling take them exactly as prescribed. Do not reduce or increase the dose. * Treatment of fluid retention depends upon the underlying cause. Since some of the causes of water retention can be related to organ disease/damage and are potentially severe, it is important that you speak with your physician or nurse promptly if you are experiencing this problem. * Fluid and electrolyte problems 2 Electrolyte imbalance * Electrolyte imbalance could also be caused by * vomiting, * diarrhea, * sweating, * high fevers, * kidney disease, * medications unrelated to cancer therapy, * certain chemotherapy drugs such as Cisplatin and targeted therapies such as Erbitux. * Fluid and electrolyte problems * Because electrolytes regulate activity of nerves and muscles, their imbalance could lead to malfunctions in multiple organ systems. * It could cause : * muscle spasms, * weakness and twitching; * irregular heartbeat and blood pressure changes; * lethargy, * confusion, and neurological problems. * Severe electrolyte imbalance can result in death. Monitoring for electrolyte imbalance is a simple process and is accomplished through routine lab work. * Fluid and electrolyte problems * Treatment of electrolyte imbalance is based on identifying and treating the underlying problem causing the imbalance, * and actively correcting the imbalance itself. * Treatment may include intravenous replacement of fluids or electrolytes, dietary changes and/or oral replacement of a particular electrolyte. * Fluid and electrolyte problems * 3. Tumor lysis syndrome Tumor Lysis Syndrome is a serious and sometimes life-threatening c omplication of chemotherapy. * . It is caused by release of breakdown products from dying cancer cells and most frequently occurs in patients with leukemia or lymphoma that have a high tumor burden (large tumor). * Patients with pre-existing kidney disease are also at increased risk for this complication * Fluid and electrolyte problems * Symptoms of tumor lysis syndrome include: * Muscle weakness * Paralysis * Heart arrthymias * Seizures * Tetany * Changes in emotional stability * Decreased urine output Changes in electrolyte and uric acid levels. * Fluid and electrolyte problems * Treated prophylatically with hydration and medications which decrease uric acid levels like Allopurinol. * Treatment for tumor lysis is directed toward stabilizing electrolyte and uric acid levels. * Aggressive hydration with IV fluids and use of diuretics may be instituted. In some cases persons have undergone renal dialysis. * C8 NUTRITION BY Schumaker and Chernecky critical Care and Emergency Nursing * Energy expenditure during respiratory failure is high and is caused by the increased work of breathing. The goal of nutritional support is to provide the needed nutrients to maintain the patients current level of : * metabolism * energize the immune system * and maintain end-organ function. * NUTRITION BY Schumaker and Chernecky critical Care and Emergency Nursing * Enteral Gi feeding is the route of choice to provide the calories and nutrients needed and to assist in maintaining normal GI: function. * if the patient is unable to tolerate enteral feedings, then a parenteral (intravenous) route is necessary until the patient can tolerate enteral feedings. * Medical Management of the Client Receiving Parenteral nutrition by Joyce Black * Parenteral Nutrition (PN). PN is indicated to maintain nutritional status and prevent malnutrition when the client has inadequate intestinal function or cannot be fed orally or by . tube feeding. * The PN prescription is guided by the nutritional assessment and the definition of nutrient goals for calories. and protein. The PN solution contains carbohydrates' as glucose, fats, triglyceride, and protein as amino acid levels designed to meet the caloric and protein need of the client. * C 9 Perioperative Problems by Carl Balita, Nursing Review * D. Psychological and Behavioral Intervention * 1. Measure to relieve anxiety * 2. Fear * 3. Depression * 4. Critical concerns life: * a. Immobility * b. Sleep deprivation * c. Sensory overload * d. body image alteration * e. Grieving * f. sexuality * g. spirituality * Psychosocial and Behavioral Intervention http://www. uspharmd. com * Anxiety * Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with threat. * Anxiety * Defining Characteristics Nursing Diagnosis Anxiety * Expressed concerns due to change in life events; * insomnia * Fear of unspecific consequences * Shakiness * Anxiety * Nursing outcome Nursing Care Plans For Anxiety: * †¢ Appear relaxed and report anxiety is reduced to a manageable level. †¢ Verbalize awareness of feelings of anxiety. †¢ Identify healthy ways to deal with and express anxiety. †¢ Demonstrate problem-solving skills. Use resources/support systems effectively. * Nursing Priority Nursing Care Plans   For Anxiety †¢ Assess level of anxiety †¢ Assist client to identify feelings and begin to deal with problems †¢ Provide measures to comfort and aid client to handle problematic †¢ To promote wellness; teaching/discharge considerations * Fear * Fear is a feeling of anxiety and agitation caused by the pr esence or nearness of danger, evil, pain, etc. ; timidity; dread; terror; fright; apprehension respectful dread; awe; reverence a feeling of uneasiness or apprehension; concern: * Interventions. The client needs an explanation of the disease and all treatment options. * Reinforce information to the client as needed. * The client also needs information concerning operative procedures and postoperative interventions (NPO status, NG tubes, other drains, intravenous infusions). * This information helps decrease the clients fear. * Understanding Depression by Health Guide . org * Feeling down from time to time is a normal part of life. But when emptiness and despair take hold and wont go away, it may be depression. * Common signs and symptoms of depression : * Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation. * Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure. * Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month. * Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia). * Common signs and symptoms of depression : * Irritability or restlessness. Feeling agitated, restless, or on edge. Your tolerance level is low; everything and everyone gets on your nerves. * Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete. * Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes. * Concentration problems. Trouble focusing, making decisions, or remembering things. * Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain. Depression * Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. * Thoughts of death or suicide are a serious symptom of depression, so take any suicidal talk or behavior seriously * Depression * Intervention: * Lifestyle changes are not always easy to mak e, but they can have a big impact on depression. * Lifestyle changes that can be very effective include: * Cultivating supportive relationships * Getting regular exercise and sleep * Eating healthfully to naturally boost mood Managing stress * Practicing relaxation techniques * Challenging negative thought patterns * Critical Concerns life: * Immobility * Sleep Deprivation * Sensory overload * Body image deprivation * Grieving * Sexuality * Spirituality * Immobility * Immobility is complications that are associated with a limited or absolute lack of movement by the patient; various members of the health care team may collaborate to assist the patient in avoiding these problems. * Nurses must -Prevent the complications of immobility, such as :pneumonia , pressure ulcers, with frequent turning or the use of an oscillating bed. Intervention: * Continue to reposition the patient to relieve skin pressure unless the bed provides more, than 40 degrees of rotation. * The eyes may need to be taped closed to avoid corneal abrasion. * Suctioning may be needed to keep the airway clear and prevent pneumonia. * Passive range-of-motion exercises keep joints mobile and minimize muscle wasting. * Position the extremities in correct alignment to prevent contractures. * Use sequential compression stockings to prevent deep venous thrombosis (DVT); low-dose heparin may also be ordered. All these complications are continually assessed for and are treated promptly if they occur. * Sleep Deprivation Sensory overload * Sleep Deprivation is a sufficient lack of restorative sleep over a cumulative period so as to cause physical or psychiatric symptoms and affect routine performances of tasks. * Sensory overload is a condition in which an individual receives an excessive or intolerable amount of sensory stimuli, as in a busy hospital or clinic or an intensive care unit. * Sleep Deprivation Sensory overload * Sleep deprivation is of particular concern for clients in critical care units. Causes of the following: * The noise level * 24-hour lighting * and frequency of caregiver interruptions create sensory overload and sleep deprivation, which is thought to be a major factor contributing to postoperative psychosis (Joyce Black) * Sleep Deprivation * Causes: * Clients who have had surgery are also at risk for sleep pattern disturbance because of disruptions in circadian rhythms. * The cause is unclear, but the disruptions may be related to the length and type of anesthesia, postoperative analgesia, or mechanisms associated with the procedure itself. * Sleep Deprivation Techniques used to promote sleep include : * massage * relaxing music * progressive relaxation techniques * Medications to promote sleep * Body image deprivation * Body image is the attitude a person has about the actual or perceived structure or function of all or part of his or her body. * This attitude is dynamic and is altered through interaction with other persons and situations and influenced by a ge and developmental level. * As an important part of one’s self-concept, body image disturbance can have profound impact on how individuals view their overall selves. * Body image deprivation In cultures where one’s appearance is important, variations from the norm can result in body image disturbance. * The importance that an individual places on a body part or function may be more important in determining the degree of disturbance than the actual alteration in the structure or function. * Therefore the loss of a limb may result in a greater body image disturbance for an athlete than for a computer programmer. * Body image deprivation * The loss of a breast to a fashion model or a hysterectomy in a nulliparous woman may cause serious body image disturbances even though the overall health of the individual has been improved. Removal of skin lesions, altered elimination resulting from bowel or bladder surgery, and head and neck resections are other examples that can le ad to body image disturbance. * Body image deprivation * Defining Characteristics: Verbalization about altered structure or function of a body part * Verbal preoccupation with changed body part or function * Naming changed body part or function * Refusal to discuss or acknowledge change * Focusing behavior on changed body part and/or function * Actual change in structure or function * Refusal to look at, touch, or care for altered body part * Change in social behavior (e. . , withdrawal, isolation, flamboyance) * Compensatory use of concealing clothing or other devices * Body image deprivation * Therapeutic Interventions * Acknowledge normalcy of emotional response to actual or perceived change in body structure or function. Stages of grief over loss of a body part or function is normal, and typically involves a period of denial, the length of which varies from individual to individual. * Help patient identify actual changes. Patients may perceive changes that are not present or rea l, or they may be placing unrealistic value on a body structure or function. Encourage verbalization of positive or negative feelings about actual or perceived change. It is worthwhile to encourage the patient to separate feelings about changes in body structure and/or function from feelings about self-worth. * Body image deprivation * Therapeutic Interventions * * Assist patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities. Opportunities for positive feedback and success in social situations may hasten adaptation. * Demonstrate positive caring in routine activities. Professional caregivers represent a microcosm of society, and their actions and behaviors are scrutinized as the patient plans to return to home, to work, and to other activities. * Body image deprivation * Education/Continuity of Care * Teach patient about the normalcy of body image disturbance and the grief process. * Teach patient adaptive behavior (e. g. , use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body part or enhances remaining part or function, use of deodorants). This compensates for actual changed body structure and function. Help patient identify ways of coping that have been useful in the past. Asking patients to remember other body image issues (e. g. , getting glasses, wearing orthodontics, being pregnant, having a leg cast) and how they were managed may help patient adjust to the current issue. * Body image deprivation * Education/Continuity of Care * * Refer patient and caregivers to support groups composed of individuals with similar al terations. Lay persons in similar situations offer a different type of support, which is perceived as helpful (e. g. , United Ostomy Association, Y Me? , I Can Cope, Mended Hearts). http://nursingcareplan. blogspot. com * Grieving by Carl Balita * Sexuality * Sexuality. Sexuality is the behavioral expression of ones sexual identity. * It involves sexual relationships between people as well as the perception of ones maleness or femaleness (gender identification). * Sexuality * Many aspects of sexuality affect health status and are significant to nursing care and client outcomes. * * Aspects include: * (1) physical health problems that affect sexual behavior * (mastectomy, colostomy, skin lesions, venereal diseases, paralysis, physical deformities) * (2) concerns with sexual performance (impotence, premature ejaculation, inability to achieve orgasm, infertility), * (3) issues of sex role function * (homosexuality, bisexuality, sexual ambiguity, transsexual surgery), and * (4) effects of environmental restrictions on sexual performance * (residency in a longterm care facility). * Sexuality * Sexuality and sexual behavior are sensitive topics. * Clients may want to discuss sexuality issues and may look for permission to do so. * Become comfortable with sexuality issues and do not allow personal beliefs and values to interfere with professional care. Accept and interact with clients without judging them or their behavior. * Spirituality * Spiritual beliefs have implications for well-being, such as sustaining hope or assisting with coping during periods of stress. * Include spirituality assessment as part of the, health history and explain the purpose for asking about it * Spirituality * . This portion of the history is usually addressed at the end of the interview after a trusting nurse-client relationship is established. * Because spirituality is personal, respect a clients wishes not to discuss this topic. Ask whether the client prefers to consult someone else wh en spiritual support is needed. * Spirituality * Nurses may be aware that patients have spiritual needs, but in many cases are unable to respond to these needs. * This may result from an inadequacy in nurse education that does not prepare nurses to provide spiritual care. (Michelle Wensley, 2011) * Supportive Management * Supportive Management * (Discussed already on MODS = Medical and Nursing Management on the previous slides) * Preventing Complications * Preventing ICU Complications * Lee-lynn Chen, MD * Assistant Clinical Professor Catheter Related Blood Stream Infection * CRBSI Prevention Bundle : * Hand hygiene * Maximal barrier precautions (mask, gown, gloves and full barrier drapes) and full barrier drapes) * Chlorhexidine skin antisepsis * Optimal catheter site selection, with subclavian vein as the preferred site for non non-tunneled tunneled catheters in adults * Ultrasound guidance * Daily review of line necessity with prompt removal of unnecessary lines * Ventilator Asso ciated Pneumonia * A leading cause of death among hospital acquired infections * Increased length of time on ventilator, in both the ICU and hospital. Estimated cost is $40,000 (2004) * Continuous Aspiration of Subglottic Secretions * Requires intubation with special tube * Separate dorsal lumen that opens in to subglottic area * Aspiration may be continuous or intermittent * Requires frequent monitoring * Pressure Ulcers * Incidence and Cost * Incidence ranging from 0. 4% to 38% * 2. 5 million patients treated annually in US acute care facilities for pressure ulcers related complications * Once pressure ulcer develops, mortality is increased by 2-6 fold with 60,000 deaths * Total annual cost $11 billion * Pressure Ulcers Definition: Localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or in combination with shear or friction. * Identifying patients at risk and identifying early skin changes can allow early intervention to pr event a pressure ulcer from developing * Pressure Ulcers: Sites * Sacrum -most common site (30%)Slouching in bed or chair * Higher risk in incontinent pts * Heels-2ndmost common (20%)Immobile or numb legs * Higher risk with PVD diabetes neuropathy * Trochanter * Device related * Minimize pressure * Frequent small position changes (every 1. to 4 hrs) * Keep reclining chair and bed below 30 degree angle to decrease pressure load * Sitting: may need hourly position changes * Increase mobility/Consult PT/OT * Order air mattress if turning protocols are ineffective * Reposition off of any know ulcers * Use pillows to pad bony prominences * Float heels with pillow lengthwise under calves * Minimize friction and shear * Use draw sheet under patient to assist with moving * Do not drag over mattress when lifting up in bed * Avoid mechanical injury-use slide boards, turn sheet, trapeze, corn starch * Manage Moisture Cleanse skin at time of soiling and use absorbent * Provide a non-irritating surface * Barrier ointments and pads * Utilize appropriate fecal/urinary collection devices * Nutrition/hydration * Skin condition reflects overall body function * Skin breakdown may be evidence of general catabolic state * Increase hydration caloric needs * Nutritional goals: ^protein intake1. 2-1. 5 gm/kg body weight daily—unless contraindicated * Consider vitamin supplementation * Rehabilitation * Rehabilitation will be properly coordinated with the Physical Therapy Department

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