Juvenile Delinquency Essay - 2029 Words

Juvenile delinquency has been around since the late 19th and early 20th century. It was at this time that the first juvenile court was created by the child savers movement (Mallicoat 2016). The rate of juvenile delinquency increased dramatically around the year 1938, which was the time that child labor laws were enforced. These laws limited the amount of time that a child could work in any given week, which gave them more free time. Because children were used to working anywhere between 50 to 70 hour weeks, they did not know what to do with their free time. So, they did what any young child would do, they started getting into trouble. At the time, juvenile delinquency only accounted for the male population. Females at the time were being†¦show more content†¦THE PROJECT When deciding on what to do for our project we looked into the types of crimes that female delinquents were arrested for and the pathways that led them to commit those crimes. When we found that a lot of girl s that are arrested are either arrested for a status offense or prostitution, we decided to look deeper into the reasons why. We found that a lot of girls that are arrested for these crimes are victims themselves. So for our project, my group wanted to highlight the particular pathway that a female offender would go through before getting arrested by creating a video. In order to conserve the amount of money we were spending, we decided that the actors for the video should be the members of the group. However, due to the fact that there were only four members within the group, and one person did not want to be filmed, some members had to play multiple parts and we had to find another person willing to be filmed and someone to edit the video. In the video, we highlight the possible issues within the family by having the mother start dating and having the boyfriend hit on the daughter. We initially wanted to have a part within the video where the boyfriend rapes the daughter off screen because rape or sexual abuse is a common theme for young girls that run away from home. It was taken out due to the lack of actors and due to the comfort level of theShow MoreRelatedEssay Juvenile Delinquency1499 Words   |  6 PagesMain Post: Juvenile delinquency is a problem that affects society as a whole. Understanding Juvenile delinquency is important because it is part of trying to figure out how people in American society should react to it; specifically, in terms of law enforcement officers, their agencies, and State legislators. When deviant behavior becomes continuous, chronic and widespread it gets perceived as a significant part of the population as threatening to the general well-being of society (ThompsonRead MoreJuvenile Delinquency Essay1646 Words   |  7 PagesA juvenile delinquent offense is an act committed by a juvenile for which an adult would be tried at a criminal court. New statistics give an alarming picture: juvenile delinquency is higher as never before. According to the census bureau, in 2008 there were 1,653,000 recorded delinquent offenses in the United States. This is a 23.6% increase from 1990 when 1,337,000 delinquent offenses occurred. Today, a lot of people demand lowering the age of criminal responsibility and draconian penalties (JensonRead More Juvenile Delinquency Essay2036 Words   |  9 Pages nbsp;nbsp;nbsp;nbsp;nbsp;Juvenile delinquents, or youth that have been convicted of a crime, seem to be the norm these days. Citizens, families, and poliy makers want new programs and policies within the juvenile justice system. Researchers have found that the family structure can be a precursor to delinquent behavior, and families do not have the control or blance that they once did. As such, mew measures need to be implemented to help these families in crisis. Rehabilitation of the familyRead More Juvenile Delinquency Essay1827 Words   |  8 Pages Juvenile Delinquency There is no doubt that various experts can give us many theories as to the causes of juvenile delinquency, including ones economic background, substance abuse, delinquent peer groups, repeated exposure to violence, increased availability of firearms and media violence. However, I feel that the number one cause of juvenile delinquency is the breakdown of families, including lack of parental control over children. It is ironic in America, today, one must have a drivers licenseRead MoreJuvenile Delinquency Essay1884 Words   |  8 PagesJuvenile Delinquency There is no doubt that various experts can give us many theories as to the causes of juvenile delinquency, including ones economic background, substance abuse, delinquent peer groups, repeated exposure to violence, increased availability of firearms and media violence, however, I feel that the number one cause of juvenile delinquency is the breakdown of families, including lack of parental control over children. It is ironic in America, today, one must have a drivers licenseRead MoreEssay on Juvenile Delinquency1652 Words   |  7 PagesJuvenile Delinquency Everyday we read in the newspaper or watch T.V and hear news of crimes committed by Juveniles. With all of the crime being reported by the media about juveniles, one can’t help but wonder if all of our nation’s youth are juvenile delinquents. Although there are many cases where the juvenile did not commit a serious crime, there are others where the crime is so bad the juvenile court system tries the juvenile as an adult. Instead of seeking help for the individual, our justiceRead MoreJuvenile Delinquency Essay2064 Words   |  9 PagesJuvenile delinquents, or youth that have been convicted of a crime, seem to be the norm these days. Citizens, families, and poliy makers want new programs and policies within the juvenile justice system. Researchers have found that the family structure can be a precursor to delinquent behavior, and families do not have the control or blance that they once did. As such, mew measures need to be implemented to help these families in cris is. Rehabilitation of the family unit is the answer, say manyRead MoreEssay Juvenile Delinquency5272 Words   |  22 PagesJuvenile Delinquency Amy Cowan CRJ 422 Prof. Angela Hermosillo November 15, 2010 Juvenile Delinquency Introduction Can we as a society truly reduce the rate of juvenile crime and violence? â€Å"Throughout all time there has been delinquency. It may not have had the delinquency label, but it still existed. Juvenile crime is mentioned as far back as ancient Sumeria and Hammurabi, where laws concerning juvenile offenders first appear in writtenRead More Adolescence and Juvenile Delinquency Essay1644 Words   |  7 PagesI couldnt begin to cover all the possible reasons that may cause an adolescent to become a juvenile delinquent. During my research, I found that the term juvenile delinquency is defined a number of ways. Mosbys Medical Nursing, and Allied Health Dictionary summed up juvenile delinquency best with this definition; resistant antisocial, illegal, or criminal behavior by children or adolescents to the degree that it cannot be controlled or corrected by the parents, endangers others inRead MoreJuvenile Delinquency Essay examples1465 Words   |  6 PagesAs stated by Bartol and Bartol â€Å"Juvenile delinquency is an imprecise, nebulous, social, clinical, and legal label for a wide variety of law- and norm-violating behavior† (2011, Pg 139). The juvenile delinquency term has come to imply disgrace in todays correctional institution. Our government is up hold to procedures and expected to come with a solution to solving the delinquent problem. An underage offender can be labeled a delinquent for breaking any number of laws, ranging from robbery to running

Benefits Of The Brother Cs6000i Sewing Machine Essay

Title: Get Introduced to the Rich-Feature Brother CS6000i Sewing Machine Description: The Brother CS6000i is here to provide new features and better sewing machine automation. You will get better sewing experience when using this machine. Introduction The Brother CS6000i sewing machine is so far the best deal you can get on sewing machines under $200. The low price does not indicate signs of a poor quality product. The manufacturer offers a 25-year warranty on the machine to show that it is durable. The manufacturer made sure to combine many features and proper automation to give the machine an edge over its competitors. Users love this machine for providing the many accessories that help in sewing. You should impress your clients by using the right type of stitches and tools to finish the sewing projects. Let us get to know the machine in detail now. Benefits of the Brother CS6000i Sewing Machine A value-packed machine This sewing machine comes packed with many features unique to it. The features of any new machine make it the best in what it can deliver. Most users would find this sewing machine as value-packed when it comes to dealing with different sewing and quilting projects. The accessories included in the compartment makes the sewing experience better. Better Performance The manufacturer has computerized this sewing machine making it better than the previous models. Since most of the functions are computerized, the operation and performance of the machine is

Classification of Milk free essay sample

Ultra-high-temperatureprocessingClassification of milk products based on the manufacturing process Milk is important for both children and adults because it is a source of minerals, calcium, protein and phosphorus. Currently, there are different kinds of milk products in the market. Here are some types of milk based on the manufacturing process: -UHT Liquid Milk UHT is stands for Ultra High Temperature Processing or Ultra Heat Treatment. It is a way to sterilize food through to high heat process about 24 seconds at 135-140 degrees Celsius which the spores of milk is destroyed completely in that temperature. The high temperature pasteurization processes was first discovered in the 1960s by used with the milk know as UHT milk. UHT milk can be stored at room temperature for 6-10 months compared with pasteurized milk. UHT milk free of preservatives because the package is made in six layers to keep the milk remains in a sterile condition within a specified period without other chemicals. We will write a custom essay sample on Classification of Milk or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Milk Pasteurization Pasteurized milk is raw milk that passed through the heat of not less than 60 Celsius for at least 30 minutes or uses the heat of not less than 73 degrees Celsius for 15 seconds. Pasteurized milk is only lasted for 14 days if not stored in the refrigerator with a temperature of 5-7 degrees Celsius. Pasteurized milk has fresh taste and features as the natural milk. -Milk Sterilization The milk will be sterilized by high heat at 120 degrees Celsius for 15 minutes and caused the whole bacteria die but the spores will still be growing. The sterilized milk is not suitable for children because some nutrients like Vitamin B1, Vitamin B2 and Vitamin C disappear during the heating process. The sterilized milk is usually packed in sealed metal cans so it can be kept up to 1-2 years and should be stored in the refrigerator after you open it to maintain the quality of milk. -Sweetened Condensed Milk 80 degrees Celsius warming conducted over three hours. It is condensed milk from which water has been removed and to which sugar has been added. It can last for year without refrigeration if unopened. Sweetened Condensed Milk is used for cooking rather than drinking. And it contains very high sugar so it should not to use to feed the baby. -Milk Powder It is a manufactured dairy product made by evaporating milk to dryness with a spray dryer or roller dryer is 200 degrees Celsius for two hours. The purpose of drying milk is to preserve it. It can be kept longer than the liquid milk and does not need to be refrigerated.

Case Study Stakeholder Identification and Prioritization

Question: What are the ways for identifying and prioritizing stakeholders? Answer: Introduction: This particular study has provided an in-depth understanding of the importance of business ethics inside the organization. Business ethics is one of the most authentic applied form of maintaining moral values and principles at the business process based on which the organizations like to precede their business. In this assignment, the study has focused to emphasize on the case study based on which the answer of three questions have been provided. This particular study highlights how the managers apply their methods in order to identify the stakeholder of their organization. The business framework of Mitchell et al. (1997) in the article A Case study of Stakeholder Identification and Prioritization by Managers has also given emphasis. What are the ways for identifying and prioritizing stakeholders? In order to identify the stakeholders, managers should first understand who the stakeholder is.Stakeholders may be an individual or a group, inside or the outside of an organization. Employees can be one of the major important stakeholders who are intimately associated with the management project of the organization. On the other hand, it can be the external customers, suppliers with the presence of whom the organization can never be run successfully(FishbeinAjzen, 2015). Therefore, while identifying the stakeholder, the managers have to follow different steps so that they can choose the right person for their company whether they are customer or the employee. Managers have to go through the methodological process based on which they can understand the current stakeholder for their project. Manager should identify those persons who have a greater impact on that particular field. On the other hand, if the managers decide to launch a new product in the market, they should identify those types of customers who would be able to purchase the product. Otherwise, this product would never be able to create a demand in the market. Therefore, identifying a proper stakeholder in the business goal is very much important for running the entire process of business systematically. Conclusion: The entire study deals with different methods of identifying the stakeholders maintaining the business values and ethics inside the organization. Several ways of identifying appropriate stakeholders inside the organization by the managers have been discussed in detail in this particular assignment. Apart from that, the study has also focused to explain the different components of managerial practices mentioned by Mitchell et al. (1997). In addition, my own point of view has also been mentioned in this particular study about the methods of identifying appropriate stakeholder in the business process. Physician Aid In Dying: The term Physician-Aid-in-Dying refers to a tradition in which a physician provides a capable, permanently ill patient with a medicine for a lethal dose of medication, only on the request of the patient when the patient has no desire to live and wishes to end his or her own life. The practice highlights the requirement that a patient must be able to take such decision only when they have limited life anticipation which is only limited to six months described under the authorisation of Washington. The term highlights that the physician provide such assistance to those patients only who are about to die and seek the help to control the time and circumstances of death as they suffering seems to be intolerable. In the above stated case both the divorced fifty-five year old man who is suffering from arthritis pain along with insomnia and the middle aged women suffering from leukaemia refused to undergo chemotherapy as because both the patients does not have the desire to live since their suffering has taken a huge toll on their life and their mental conditions does not support their life supporting system. Recent study has shown that both the physician and the patient undergoes prolonged and detailed discussion on ending the life support. When a patient makes an informed decision to refuse to take the life supporting health treatment their wishes are often respected given the amount of sufferings they undertake. Hence the right of a competent patient refusal to accept those sustaining treatment is legally supported by law. However a critically ill patients who only has limited number of days left of his life may ask for a dosage of pain relief medicine which generally has side effects which may make haste death for example impairing respiratory system. Since the primary objective is to relieve the suffering of patients where as the secondary motive is to hastening death which is recognised as an anticipated and often accepted side-effect in critically ill patient. A look at Ethics in the Global Market Place The term ethical issue or situation relates to a person or an organistion which authorises them to make a choice between the available alternatives which should be evaluated whether it is ethical or unethical. The above case study is of Foxconn which is a Taiwanese firm having its operations in china dealing in electronics. There are two kinds of Globalisation, one involves marketing and the other involves production. Hence at present the study shows that globalisation has positive impact in sourcing the goods and service all around the globe. Therefore Foxconn which is a globalised company produces and assembles customer oriented electronics products at a lightning fast speed. However the company has a prolonged history of unethical practice. Majority of employees have complained about the long working hour and the overtime they work in the factory for which they are not even paid rightly so. Of late it has been learnt that foxconn emphasises school students for internships as they can avoid the signing contract than those normal workers, which ultimately deprives the young workers from trade union as students are not employees of the company and hence they are not under any regulations to be protected by the labour laws. Foxconn treats its workers in an in human manner which often leads to employees of the company to question them about the ethical working of the company. Workers in Foxconn are subjected to long working hours with no outside connecting link and they often dont have the permission to talk to each other as life inside the factory is difficult. Workers often complain that they dont have the facility to meet or talk to their family and sleep in small room with strangers for which they have to pay. The human resource management of the company is responsible for maintining the working the working hour of the employees at factory along with the working conditions. It is the duty if the factory supervisor to maintain the time record of employees and reporting the same to the departmental managers. The time record must record the total number of hours worked by each employees in the factory. On the other hand if a global companies like apple who wishes to outsource work with the third party generally looks for ethical model of a company with its working environment. If a company has maintains proper working environment and meeting the regular norms of labour laws then it may attract foreign company for outsourcing its work at cheaper cost. Reference List: Fishbein, M., Ajzen, I. (2015).Belief, attitude, intention, and behavior: An introduction to theory and research. Hoffman, W. M., Frederick, R. E., Schwartz, M. S. (Eds.). (2014). Business ethics: Readings and cases in corporate morality.John Wiley Sons. Jennings, M. (2014).Business ethics: Case studies and selected readings. Cengage Learning. Weiss, J. W. (2014). Business ethics: A stakeholder and issues management approach. Berrett-Koehler Publishers.

17 Exploratory Essay Topics on Anthropology of Mormonism

17 Exploratory Essay Topics on Anthropology of Mormonism When you are writing an exploratory essay on the anthropology of Mormonism, you have to focus only on facts. Writing about a religion gives you the perfect opportunity to review only facts and alleviate all personal opinion or personal bias from the writing. The focus on anthropology means you are forced to focus on some aspect of the society, the culture, or the people within Mormonism. This opens you up to a wide array of potential topic ideas. But no matter what type of thesis you select for your writing, you must back up all claims you make with facts, and facts alone. It is for this reason that you will find some interesting anthropological facts below to help you out with your writing: Mormons first arrived in the Great Basin of Utah and were sent west. Many of the settlements were short-lived but their communities did extend from the south of Idaho all the way to California. It was during this time that the federal government would arrest many members who practiced polygamy, as it was a felony, and as such some fled to the northern areas of Mexico or the southern regions of Canada. Missionaries for the church were sent throughout the whole of the United States as well as northern Europe in order to spread the word of their church and those who wanted to convert, were given help from church-sponsored ships which carried emigrants to America. Once those converts reached the United States, they went as far as they could by rail and then by wagon for the remainder of the way. Those who were unable to afford a wagon sued a handcart. It was the Perpetual Emigrating Fund which was established to help new arrivals. The Mormons believed that their marriages must be performed inside of the Mormon temples and that families are sealed for eternity. This means the extended family as well, which is why the members of the church practice special endowment sessions and complete baptisms for the dead for those members who were not converts at the time of their death. The Mormon church emphasizes weekly family home evenings, evenings in addition to regular worship which focuses on scripture reading, singing songs, playing games, and enjoying refreshments. Church leaders ask that their members remain self-sufficient but there is a welfare system within the church which is designed only for members in need. The leaders ask all members to fast one Sunday per month and donate the money that they would have spent on meals for that day on the needy. In order to prepare for times of emergencies, leaders ask their members to have one years’ worth of food and supplies saved. When newcomers were brought en masse by the Mormon church from Europe, a 1903 disagreement of the celebration of European holidays was the foundation for a remark by the church president that all members who emigrated should learn English as quickly as possible, should adopt the customs and manners of Americans, and should work to become good and loyal citizens of America so as to demonstrate that they are faithful members through their food works. Mormons in the 19th century practiced polygamy, voted as a block, and lived as one unit. In 1978 the Mormon church changed their policy to allow blacks to hold their high levels of the priesthood. Mormons emphasize education, and as a result they have a highly educated populace. Over half (53.5 percent) of the Mormon population has, to this day, some post-high school education compared to only 36.7% of the rest of the population. Mormons observe all national holidays celebrated by Americans, and in addition to that the state of Utah has Pioneer Day on July 24 to honor the entrance into the Salt Lake Valley by Brigham Young in 1847. The Mormon teachings state that members cannot consumer hot drinks, tobacco, or wine and other alcohols. They should also consume meat sparingly and use wheat and herbs often. Today coffee and tea are also not allowed. Health studies have revealed that Mormons living in Utah have lower rates of diseases, particularly cancers, something attributed to their strict diets and restrictions against alcohol and tobacco. By maintaining strict genealogical records and having a high birth rate, the Mormon population has helped to advance research, particularly cancer research by encoding this information. From it researchers have identified the gene which most often occurs in colon cancer research and has helped identified high risk cancer patients. Leaders within the Mormon church encourage their members to depend upon the power of their God by receiving blessings from priesthood holding male members of the church. Historically both men and women were allowed to give blessings, in many cases women blessing other women at the time they had children, but today only the men who hold the priesthood can give out any blessing. Mormons are found around the world, but their church is located primarily in America. The church retains local leaders who are representatives of the international membership. Of these leaders there is a council of twelve, all of whom are white, American males. Of these one is the president of the church, when the president dies, one of the senior members of this council will replace them. The church leaders stress that marriage must be done within the same racial and religious groups, so as to avoid even more challenging marriages. It is also considered to be a mortal sin to have sex outside of marriage, which is why Mormon women marry at ages younger than most women in America. Additionally, it is discouraged to date until the age of 16 for women, and not until after the males have returned from serving a two year church based mission which lasts from 19-21, for men. With regard to political issues, the president of the church will tell his members how they are to vote, or at least feel with regard to current issues. In spite of there being no mixing of church and state, there is no ruling that churches cannot tell their congregations how to vote in matters of the state. These facts will greatly combine with 20 topics on anthropology of Mormonism because they based on this information. If you have difficulties with writing essay itself, check out our writing tips on exploratory essays. References: Allen, James B., and Glen M. Leonard.  The Story of the Latter-day Saints,  second edition. Salt Lake City: Deseret Books, 1992. Bush, Lester E.  Health and Medicine Among the Mormons: Science, Sense, and Scripture.  New York: Crossroads, 1993. Cornwall, Marie, Tim B. Heaton, and Lawrence A. Young.  Contemporary Mormonism: Social Science Perspectives.  Urbana: University of Illinois Press, 1994. Hansen, Klaus J.  Mormonism and the American Experience.  Chicago: University of Chicago Press, 1981. Hill, Marvin S.  Quest for Refuge: The Mormon Flight from American Pluralism.  Salt Lake City: Signature Books, 1989. Mauss, Armand L.  The Angel and the Beehive: The Mormon Struggle with Assimilation.  Urbana: University of Illinois Press, 1994. Shipps, Jan.  Mormonism: The Story of a New Religious Tradition.  Urbana: University of Illinois Press, 1985.

Women in the Civil War essays

Women in the Civil War essays Many women played many different and important parts in the Civil War. Some famous women from the Civil War include Rose Greenhow, a spy, Clara Barton, a nurse, and Harriet Tubman. Some women helped with the war effort from their homes, while others went to the battlefields to make themselves useful. Womens contributions are probably more widely thought of on the battlefield. Most helped with aiding wounded soldiers. Some nurses, like Clara Barton, went out onto the fields, risking their lives, during battle to comfort dying soldiers and take care of wounded ones. Other women, such as Sarah Edmonds, passed themselves off as men to act as soldiers during battle. It is estimated that hundreds of women pretended to be men to join the army. Many were wounded or even killed. A few women acted as spies, the most famous of them was Rose Wild Rose Greenhow, who worked for the Confederate Army. One woman who acted for the Union was Dr. Mary E. Walker, who was awarded the Congressional Medal of Honor for her work as a spy, soldier, and surgeon. Still, even some other women acted as maids and cooks for different brigades while at camp. These women tried to encourage troops at times of battle. The women on the battlefields were the only ones who took care of men who were wounded or dying. Without them, the casualties might have been even more drastic and those who did die felt a little better having a nurse there with them. Also, the soldiers, while very few of them, were important because they werent supposed to be in battle but came anyway. Women spies of course, had great effects, because they would be less suspected than a man during times of war. Rose Greenhow had an enormous effect on the Battle of Bull Run. Women who stayed at home also contributed to the Civil War. Women had to take over the jobs that were usually held by men. Wartime volunteers became abundant. They organized the U.S. Sanitary Comm...

SB 76 Term Paper Example | Topics and Well Written Essays - 750 words

SB 76 - Term Paper Example The law establishes the MHSO and Accountability Commission. Significantly, the commission is mandated to conduct annual review and approve mental health programs at county level for expenditures such as innovative programs, prevention and early mitigation programs. Moreover, the law authorizes the SDMH to enhance technical assistance to mental health initiatives at county levels, as specified. The bill would terminate the requirement for such annual reviews and authorize the commission, to offer technical expertise to mental health initiatives in the counties (Base, 2012). Currently the law requires health programs in the counties to produce a project that would serve three years to be updated annually and seek the approval of the department after its review and the commission’s comments. The bill would terminate the annual requirement for updating the 3-year initiatives and the requirement for approval by the department preceded by review and commission’s comments. The act restricts funds from the MHSF from supplanting the state funds used to provide psychological services. In addition, it requires financial support of the state for mental health activities with hardly the same entitlements, allocations from the GF. The bill shall order the state to administer the fund as opposed to the department. Additionally, it would authorize for a continued financial support for mental health initiatives from the collection of local revenue. The Treasury of the state would, require the Controller to disseminate to the counties all unutilized and unreserved funds in the MHSF monthly (Hall, 2009). Under the law, money in the MHSF may be utilized only for recognized purposes, including 5% for innovative initiatives, as stipulated and 5% for departments administrative costs, the CMHPC. The bill, 2012, would allocate certain funds in the MHSF to cater for Medical specialty in the mental health services. For instance, through those funds for special pupils and th e Periodic Screening, and Treatment program. Consequently, the allocation of funds in the MHSF for other purposes would make the bill an appropriation (Keithly, 2012). The act demands the department to establish regulations, which may serve as crisis solvers and the designated local agencies to execute the enacted act. However, the bill would declare its consistency with the act; hence, it furthers the purpose. The Constitution in California has authorized the administrator to announce a monetary emergency and call the Legislature into a special session for the above purpose. Significantly, Governor Schwarzenegger produced a proclamation ordering a fiscal emergency, and that necessitated a critical session for the same purpose. Additionally, in December 2010. Governor Brown produced a proclamation in January 2011, as declaration, a reaffirmation that a fiscal emergency disappears, and postulating that his proclamation had superseded the earlier proclamation on the provision of the c onstitution. However, the bill would postulate that it handles the fiscal emergency as declared by the reaffirmation of the Governor by his proclamation produced in January 2011, pursuant to the constitution of California. Arguments for the SB. 76 In conclusion, it is significant to highlight the numerous arguments for the support of the SB. 76. According, to a legislation committee in California referred to as Friend’

A Women's Dillema Between Her work and Family Essay

A Women's Dillema Between Her work and Family - Essay Example At the lunch hour, she picks all of her children, drop them home and then returns to work. By the time she gets home in the evening, she is drop dead tired, but she still fix a decent meal for her family and put all of her children to bed before she retires herself. She also watches television with her husband and has healthy discussions about family matters, politics and work related issues. Before she hits the bed, she irons everyone’s clothes for the next day and then manages to get a shut eye of five hours, at most. On Sundays she does all the extra work like grocery shopping and laundry. She is a perfect example of what we call as a super lady. Though, Alena dutifully accomplishes all her responsibilities, she still gets to face her husband’s sarcasm about how she didn’t groom her children properly because she’s been working. She has to hear her children’s complaints about how she doesn’t look after them that well though she doesn’t lack anywhere. Women today have to face a lot of challenges when they decide to satiate the career oriented lady in them ranging from society’s disapproval to the family’s grunts. The statuses of working women have become better than what it was some 20-30 years ago. Isn’t it an accomplishment that they are not regarded as careless vamps who had no rights to vote

State and Society in 20th Century China Essay Example | Topics and Well Written Essays - 2000 words

State and Society in 20th Century China - Essay Example The consumer-centric trading model has also helped China bring down the increasing currency exchange rates, which had caused great uproars in international financial domains, particularly during the recent economic recessions. It may be noted that the Chinese society espoused consumerism with regard to currency exchange rates, amendments in property ownership acts, and de-institutionalisation of political authority over various prefectures. It is quite logical to state that such a shift in socio-economic spheres has not been an easy ride. The erstwhile communist austerity gave way to broader perspectives in all walks of life in China. Most notably, the emerging middle-class segment of the country has been able to find jobs in private sectors, but at the cost of state-owned jobs. This downsizing in state firms has implicit connection with the drooping economic conditions around the world. Standard societal structures in China have faced major challenges in sustaining the development programs the scope of which has been increasing everyday as the country is attracting more and more foreign direct investments in the economic upfront. Urbanization too has posed problems for the otherwise bureaucratic state mechanism to effectively control massive intra-country migrations (Lieberthal). Under these circumstances, China has been the center of global affairs, for better or worse, in the last few years. This paper is going to d iscuss the difficulties faced by the current Chinese leadership in dealing with issues of national interest. The study will also take into consideration how well the Chinese government is adept at handling such issues. Given the sheer geographical vastness of the land, it is quite apparent that the reformist means undertaken by the Chinese political regime face serious societal and economic challenges. Moreover, there is

Dementias Effect on the Visual System

Dementias Effect on the Visual System Abstract Recent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatmen t of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved. (1) Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also c ause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1. In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4. Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2. Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purpose Table 1 : Vision tests for possible early detection and monitoring of Alzheimers disease Use Benton visual retention test Might be able to predict risk for AD 10-15 years before the onset of the disease Tests visual memory Contrast sensitivity AD patients have selectively reduced CS for distinguishing large objects and faces Useful field of view Tests processing speed, divided attention and selective attention Facilitates detection of â€Å"attentional dysfunction†; patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned background Could be useful to assess fitness to drive Facial recognition AD patients do not recognize faces with large features and low contrast AD patients do not recognize familiar faces (due to impaired memory) Tests that use facial expressions with progressively diminished degree of contrast The aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients. (2) Alzheimers disease Alzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease. Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise beco me lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. (3) Visual Changes in Alzheimers Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common. Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14. (3.1) Some of the main changes that occur in the eye with aging include: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in literature are outlined below: (3.2) Anatomic Abnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989); (Tsai et al, 1991); (Hedges et al, 1996 Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants. Macular cell loss (Blanks et al, 1990) Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals. Supranuclear cataract (Goldstein et al, 2003) Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999); however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from AD; Exfoliation (Janciauskien and Krakau, 2001) Abnormal pupillary innervation [109-113] Glaucomatous optic nerve cupping (Bayer et al, 2002) (3.3) Functional Decreased visual acuity (Holroyd and Shepherd, 2001) Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002) Visual field loss (inferior) (Trick et al, 1995) Reduced contrast sensitivity (Holroyd and Shepherd, 2001) Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991) Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001) Delayed saccadic eye movements (Holroyd and Shepherd, 2001) (3.4) Cognitive Abnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000) Inability to recognize depth (Holroyd and Shepherd, 2001) Impaired face recognition (van Rhijin et al, 2004) (3.5) Other Excessive pharmacological mydriasis/miosis [109-113] These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames19. Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20. Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1 Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22. Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. (4) Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease . Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2. During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1. Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. (4.1) Internal ocular health examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdg There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals t ested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients. (4.2) Objective Refraction examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff Dementias Effect on the Visual System Dementias Effect on the Visual System Abstract Recent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatmen t of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved. (1) Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also c ause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1. In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4. Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2. Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purpose Table 1 : Vision tests for possible early detection and monitoring of Alzheimers disease Use Benton visual retention test Might be able to predict risk for AD 10-15 years before the onset of the disease Tests visual memory Contrast sensitivity AD patients have selectively reduced CS for distinguishing large objects and faces Useful field of view Tests processing speed, divided attention and selective attention Facilitates detection of â€Å"attentional dysfunction†; patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned background Could be useful to assess fitness to drive Facial recognition AD patients do not recognize faces with large features and low contrast AD patients do not recognize familiar faces (due to impaired memory) Tests that use facial expressions with progressively diminished degree of contrast The aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients. (2) Alzheimers disease Alzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease. Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise beco me lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. (3) Visual Changes in Alzheimers Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common. Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14. (3.1) Some of the main changes that occur in the eye with aging include: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in literature are outlined below: (3.2) Anatomic Abnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989); (Tsai et al, 1991); (Hedges et al, 1996 Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants. Macular cell loss (Blanks et al, 1990) Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals. Supranuclear cataract (Goldstein et al, 2003) Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999); however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from AD; Exfoliation (Janciauskien and Krakau, 2001) Abnormal pupillary innervation [109-113] Glaucomatous optic nerve cupping (Bayer et al, 2002) (3.3) Functional Decreased visual acuity (Holroyd and Shepherd, 2001) Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002) Visual field loss (inferior) (Trick et al, 1995) Reduced contrast sensitivity (Holroyd and Shepherd, 2001) Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991) Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001) Delayed saccadic eye movements (Holroyd and Shepherd, 2001) (3.4) Cognitive Abnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000) Inability to recognize depth (Holroyd and Shepherd, 2001) Impaired face recognition (van Rhijin et al, 2004) (3.5) Other Excessive pharmacological mydriasis/miosis [109-113] These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames19. Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20. Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1 Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22. Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. (4) Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease . Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2. During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1. Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. (4.1) Internal ocular health examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdg There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals t ested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients. (4.2) Objective Refraction examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff

Essay --

Harrison Gardner Mr. Pickett Language Arts 3rd Period 2014 March JFK Assassination Theories Around 12:30p.m. in Dallas, Texas, President John Fitzgerald Kennedy was riding in a motorcade passing the Texas School Book Depository building when he was assassinated.(â€Å"Know the Knoll: Knew Angles on JFK Assassination†) Most people think that three shots were fired. Two hitting Kennedy and one hitting Governor John Connally.(â€Å"LEE HARVEY OSWALD†) Shortly after the assassination Lee Harvey Oswald was arrested for killing a policeman, J. D. Tippit, for stopping him in a neighborhood. Soon after being arrested an employee from the Texas School Book Depository Building recognized Oswald which is when the police figured they had likely caught the president’s killer. When Oswald was being taken to the county jail he was shot by a nightclub owner named Jack Ruby.(â€Å"Accused JFK Assassin Is Arrested, Then Gunned down.†) For many people it was simple, Oswald was Kennedy’s killer. But if you are like most people you think Oswald did not act a lone, or maybe did not even have anything to do with the assassination. There are many theories of how, why, and who killed Kennedy, but some of them are more popular and make more sense than others. For example the grassy knoll theory which is the theory that there was a gunman on the grassy knoll, either assisting Oswald or acting alone.(â€Å"Dealey Plaza and the Grassy Knoll.†) In Oswald’s single gunman theory, Oswald was on the sixth floor of the Texas School Book Depository building with a bolt-action sniper when he fired the three shots that killed the president and injured governor Connally. The rifle Oswald used was found on the sixth floor which was a good spot for him to kill kennedy. Many people say tha... ...in real life say that the wall would have been too short for an average person to stand behind it and only have a head and torso showing. They also say it was too tall for an average person to be kneeled down behind the wall but still have a head and torso still showing. The grassy knoll theory and the theory that Oswald killed JFK are only two of the many theories about his assassination. There are many completely different theories and there are many little theories that base off of one big theory such as the badgeman theory comes off of the grassy knoll theory. Even though Kennedy was killed more than fifty years ago most people still do not think Oswald was a lone gunman. Since this event happened many years ago it is hard to gather new facts to prove the theories right or wrong. Even if Oswald was arrested for Kennedy’s murder we still may never know the truth.

Nursing Care

Nursing Diagnoses: (include 1 psychosocial)1. Impaired Gas Exchange related to thoracotomy as evidenced by O2 via NC, L side chest tube, Hx of asthma, Obesity, chest x-ray showing congestion and atelectasis in the left lower lobe, and SOB on exertion.2. Acute Pain related to surgical incision as evidenced by patients verbal report of pain (rated at a 10 on a scale from 1-10), positioning to avoid pain, elevated systolic blood pressure, facial grimace, decreased ambulation and movement to avoid pain.3. Impaired Skin Integrity related to a thoracotomy procedure as evidenced by a L lateral incision post Thoracotomy for resection of mediastinal cyst and report of pain in the affected area.4. Infection related to thoracotomy as evidenced by elevated WBC’s (17.8) and traumatized tissue from surgery.5. Knowledge deficient related to lack of exposure of surgical procedure recovery as evidenced by patient’s statement, â€Å"I did know I would be in the hospital this long† .Nursing Diagnosis # 1: Impaired Gas Exchange related to thoracotomy as evidenced by O2 via NC, L side chest tube, Hx of asthma, Obesity, chest x-ray showing congestion and atelectasis in the left lower lobe, and SOB on exertion.Goal: Pt. will have adequate oxygenation and absence of shortness of breath within 2 days.Interventions:1. Auscultate breath sounds every 4 hours and note adventitious sounds, note respiratory rate, depth, and use of accessary muscled. Encourage the use of the incentive spirometer and deep breathing exercises every hour, stressing the important role it plays in her progress.2. Review and compare chest x-rays once a day, review notes written in final report.3. Monitor Intake and Output every 2-4 hours4. Elevate the head of the bead every day to maintain open airway.5. Encourage deep breathing, coughing exercises, and the use of incentive spirometer every hour.Nursing Diagnosis # 2: Acute Pain related to surgical incision as evidenced by patients verbal report of pain (rated at a 10 on a scale from 1-10), positioning to avoid pain, elevated systolic blood pressure, facial grimace, decreased ambulation and movement to avoid pain.Goal: Pt. will verbalize pain is relieved within 30 minutes to an hour after analgesic administration.Interventions:1. Determine the severity, location, description, and possible pathophysiological causes of the pain every time you interact with the patient. (Use pain scale)2. Provide comfort measures every 2 hours to prevent aggravation of the pain; explore touch, repositioning, imagery, distraction, presence, or heat packs.3. Medicate as ordered with analgesics at scheduled times to maintain patient’s pain goal. Use timely interventions every time you interact with the patient and asses pain to be successful in alleviating pain. Notify physician if regimen is inadequate to meet patients control goal.4. Evaluate the client’s response to analgesia an hour after administration.Nursing Diagnosis # 3: I mpaired Skin Integrity related to a thoracotomy procedure as evidenced by a L lateral incision post Thoracotomy for resection of mediastinal cystGoal: Pt. will display timely healing of surgical wound by discharge.Interventions:1. Note the incision for color and texture including observations of any bleeding or discharge every 4 hours.2. Inspect the surrounding skin for erythema, induration, and maceration every 4 hours.3. Use appropriate barrier dressings every day as ordered.4. Keep incision clean and dry and prevent infection by hand washing and standard precaution every time you come in contact with the wound.